What is Up with Bilateral Procedures and Medicare???

[broncsrox]

Though our office cannot find any documentation or articles from CMS we are now being denied for bilateral procedures. We use a 50 modifier with 1 unit, double price. The denials are for invalid or improper modifier for bilateral hip x-rays. Last time I checked my anatomy book humans still had 2 hips not one. Anyone else experiencing this?

 

[cconroycpch]

If you are billing with cpt code 73520, there is no need to put the modifier of 50 as the code states it is bilateral. That is why the modifier is invalid and improper. You should keep the number of units as 1, but should not be doubling your charge. You may have to review your chargemaster to ensure that codes are being charged correctly.

 

[jamiebangs]

we have had denials in the past for using the 50 modifier and were advised to separately bill using an RT and LT modifer.

 

[RebeccaWoodward*]

But...to reiterate what "cconroycpch" stated...

73520 covers bilateral hips...min. of 2 views. 73520 has a bilateral payment indicator of 2.

2=Do NOT bill modifier 50-unit is 1