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Thread: Bilateral procedures - Am new to ENT coding

  1. #1
    Join Date
    Apr 2007

    Default Bilateral procedures - Am new to ENT coding

    AAPC: Back to School
    Am new to ENT coding and have a question regarding billing bilateral procedures. Everyone I have talked to gives different answers, so am not sure what to go with. Would you bill say a 69436 tympanostomy as one line item with the -50 and the price at 150%; or do we bill it as two line items with the -50 on the second code. Also, if we bill it as two line items, would we charge full price for the second code and let the insurance comp reduce it on their own? I'm really confused with all of this for now! Any help would be appreciated.

  2. #2
    Join Date
    Apr 2007


    Good Morning I would bill two lines with the same amt for each line. The insurance company will take the proper adjustments.

    69436 RT
    69436 LT 59

    I hope this helps
    Jill M. Grier CPC
    2016 New Membership Development Officer
    Professional Coders of Tidewater
    Chesapeake, VA

  3. #3
    Join Date
    Apr 2007


    First rule of thumb is never reduce your charge-leave that up to the insurance company-if you reduce your charge you may not get the full amount that is owed to the physician.
    Second, my advice would be to check with the insurance companies to see how they prefer the bilateral codes to be submitted to them. I would start with your biggest payors first. We have to send our bilat's one way to our Medicare Carrier(one line item with the 50 modifier x 1 unit and we double our charge)and a completely different way to one of the local HMO's (one line item without any modifer-second line item with a 76 modifier).....so it all depends.

  4. #4
    Join Date
    Apr 2007


    I agree with AndieL. Never reduced your charge (let the insurance companies do that) I work in an ENT group and we have to bill our bilateral procedures differently depending on the insurance carrier. I would also suggest contacting your carriers and finding out exactly how they would like bilateral procedures billed. You might find that info on each carriers website, too.
    Billing bilateral procedures incorrectly could result in lower reimbursement or denial for duplicate line times, which will take you even more time to correct and resubmit- delaying payment even more. I hope this helps.
    Eileen Roland, CPC
    Stow, OH

  5. #5
    Join Date
    Apr 2007


    different insurance have different rules, Aetna requires us to bill seperatly...69436 on one line and 69436-50 on the second line..full amount on first line and 1/2 rate on the second, if this makes sence...no need for LT and RT...but this is our rule and how we do it...check with insurance
    most times its...69436-50 on one line with full amount...just my input

  6. #6
    Join Date
    Apr 2007
    South Salt Lake

    Question Bilateral and multiple procedures

    I have a question- We have been having trouble with one of our insurances paying for the full sinus surgery. When we submit we use the following, do you bill it out this way also? The other question is would you bill the highest bilateral procedure 1st?


    I would appreciate any advice anyone could give me on this. Thanks

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