Wiki Vascular Billing Question for CPT 36475

[humowitz@sbcglobal.net]

Hi
Im new to vascular coding.

We bill a lot of 36475 (ablation) codes. I was told NOT to put a RT or LT modifier on this code for Medicare claims.

Well, now we are getting a bunch of denials from medicare and the denial code on says missing/incomplete/incorrect information. Couldn't stay on hold all day with ,medicare, but I'm wondering if I was misinformed. i wanted to get a consensus before I went ahead and added LT or RT and resubmitted corrected claims. Thanks so much

 

[lgardner]

per EncoderPro and the Auditors' Desk Reference, 36475 has a bilateral indicator of '1', which means that it can be billed with a Modifier -50.
per the Auditors' Desk Reference (paraphrased):

if the CPT code has a bilateral indicator of 1, "submit to Medicare as a one-line ite4m, CPT code xxxxx-50"
"Medicaid or a commercial payer, may require two-line items:
xxxxx
xxxxx-50
OR
xxxxx-RT
xxxxx-LT