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20610 bilateral hip injection/mod 50

  1. Default 20610 bilateral hip injection/mod 50
    Medical Coding Books
    Hello,
    Can someone tell me the appropriate way to bill a bilateral hip injection. Can you use modifier 50 with 20610? Can someone verify the status indicator? I am hearing that it is a 1, which states mod 50 does not apply, but I just referenced that it was a 2, which states it does apply????

    Thanks!

  2. Default
    Quote Originally Posted by letisha View Post
    Hello,
    Can someone tell me the appropriate way to bill a bilateral hip injection. Can you use modifier 50 with 20610? Can someone verify the status indicator? I am hearing that it is a 1, which states mod 50 does not apply, but I just referenced that it was a 2, which states it does apply????

    Thanks!
    Status indicator 1 means you can bill as a bilateral code.
    And when I code 20610 bilaterally I use RT, LT but it all depends on how the payer wants it billed. Some ins companies may want 20610, 20610-50 or just 20610-50, or 20610-RT, 20610-LT. Where I am RT, LT works for me.

    go to pg 13, that tells what the status indicators mean for bilateral (50)
    http://www.cms.hhs.gov/Transmittals/...ds/R1358CP.pdf

  3. #3
    Location
    North Carolina
    Posts
    3,126
    Default
    Bilateral Indicator:

    0=Do not submit procedure with mod 50
    1=modifier 50 applies
    2=Do not submit procedure with mod 50
    3=modifier 50 applies
    9=Concept does not apply-Do not submit modifier 50

    20610 has a indicator of 1-Modifier 50 could apply if bilateral. This can be located by selecting the "payment status indicator" and entering your CPT code.

    http://www.cms.hhs.gov/pfslookup/02_PFSsearch.asp

    As for the modifier...some carriers prefer 50, one line, one unit. Some carriers prefer LT/RT modifiers. There are many discussions from previous threads... Best advise...contact your carrier for their policy on bilateral procedures.

  4. #4
    Default
    I am having a little bit of a hard time using that particular website. Does anyone know of another website that might also be helpful to me for status indicator information? I am fairly new to all of this and could definitely use some more hands on information.

  5. Default
    What are you not understanding on the website I gave you? I can try to explain it.
    Starts on pg 13 and tells what each indicator means, if it shows a 0 in the bilateral column of the payment policy for mcare then that code is not a bilateral code, if shows a 1 then that is a bilateral code, 2 not bilateral and so on. Number 1 is the only indicator that shows it can be billed out bilaterally.
    Bilateral Surgery Indicator (Modifier 50)

    0 = 150 percent payment adjustment for bilateral procedures does not apply.

    1 = 150 percent payment adjustment for bilateral procedures applies.

    2 = 150 percent payment adjustment for bilateral procedure does not apply.

    3 = The usual payment adjustment for bilateral procedures does not apply.

    Please let me know if that clearifies it better.

  6. #6
    Location
    North Carolina
    Posts
    3,126
    Default
    Do you want to know what each payment status indicator represents? This links provides a nice breakdown.

    http://www.medtronicsofamordanek.com...indicators.pdf

  7. #7
    Default
    Thanks, girls! Both of those responses helps me a great deal!

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