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Cpt 20950

  1. Default Cpt 20950
    Medical Coding Books
    Doc put Mod 50 on this code and biller put through. The code is hitting an edit from the insurance company. He performed this procedure on both the lower rt and lt extremities during a consult (99243). Should this be coded with rt and lt mods? 2 units? or does this code gets billed once, no mods, units, etc. Thanks for your help.

  2. #2
    Location
    San Antonio, Tx
    Posts
    73
    Default
    Depending on the insurance carrier, you can bill this 20950-RT, 20950-LT or 20950-50. Your editing issue is more than likely due to your consult needing a modifier 25 or 57 depending on the place of service. Did you have a modifier on the consult?
    Ray Galvez CPC

  3. #3
    Location
    North Carolina
    Posts
    3,126
    Default
    Bilateral payment indicator for this code is 0 (zero)

    0 = 150% payment adjustment for bilateral procedures does not apply

    In an Orthopedic Pink Sheet it states...

    "The AMA states you can report 20950 per muscle compartment checked. For instance, if your doc is checking the muscles in the lower extremity, such as the anterior, posterior and lateral compartments of the tib/fib, then you can bill times 3. Make sure that your documentation supports that the wick was placed in each of the three different muscles. The report must also include the pressure readings."

    If your carrier follows this guideline, you may need to check their requirements for reporting multiple units.

  4. Default
    It was coded with a 24 modifier. Thanks so much!!!!!

  5. Default Update on CPT 20950
    The information on CPT 20950 that was listed below appears to be outdated and inaccurate. The most current information on this subject appears to be from August 2004, while the Ortho pink sheet that was referenced was from July 2004. The context behind the July 2004 communication stated that the AAOS and the AMA could not agree at that time on how CPT 20950 was to be billed. The quote starting with "The AMA states you can report 20950 per muscle compartment checked" was updated in the following Ortho Pink Sheet (August 2004). It states the following:

    "It took some debate, but the American Medical Association (AMA) and the American Academy of Orthopaedic Surgeons (AAOS) now agree that 20950 (monitoring of interstitial fluid PRESSURE (includes insertion of device, eg, wick catheter technique, needle manometer technique)) is not billable per muscle group because any additional work to insert the catheter in different muscles of the same muscle group does not meet the requirements for individual reportage of 20950. “After considerable discussions with the coding committee of AAOS, they have provided the following guidance based on their belief that while per muscle would seem to be appropriate, the work required to install the catheter is limited and thus does not warrant reporting per muscle,” says an AMA spokesperson.

    They give this example on how these codes should be used.

    For instance, if your doc checks the four muscles in the leg, then you would only bill 20950 only once. However, if the doc measures the pressure in the thigh and leg you would report 20950 twice, and if the procedure was performed bilaterally, you could still bill 20950 twice by appending modifier -50 (bilateral procedure).

  6. #6
    Location
    North Carolina
    Posts
    3,126
    Default
    You may have some issues with Modifier 50 for Medicare...

    Payment Policy Indicator 0 – 150 percent payment adjustment for bilateral procedures does not apply. The bilateral procedure is inappropriate for codes in this category because of physiology or anatomy or the code descriptor specifically states that it is a unilateral procedure and there is an existing code for the bilateral procedure

    http://www.cms.hhs.gov/pfslookup/02_...es&next=Accept

  7. #7
    Location
    Milwaukee WI
    Posts
    4,466
    Default Why mod 24?
    Quote Originally Posted by skorkfranks View Post
    It was coded with a 24 modifier. Thanks so much!!!!!
    Why would this be coded with mod 24 (unrelated E/M iby the same physician performed in postoperative period)? You mentioned this was done in the course of billing a consult? You can't consult with yourself.

    Just curious. Maybe this was a typo.

    F Tessa Bartels, CPC, CEMC

  8. Default
    99243-25, 20950-lt, 20950-59rt

  9. #9
    Location
    Houston Med Center
    Posts
    7
    Default
    Quote Originally Posted by jnsummer View Post
    The information on CPT 20950 that was listed below appears to be outdated and inaccurate. The most current information on this subject appears to be from August 2004, while the Ortho pink sheet that was referenced was from July 2004. The context behind the July 2004 communication stated that the AAOS and the AMA could not agree at that time on how CPT 20950 was to be billed. The quote starting with "The AMA states you can report 20950 per muscle compartment checked" was updated in the following Ortho Pink Sheet (August 2004). It states the following:

    "It took some debate, but the American Medical Association (AMA) and the American Academy of Orthopaedic Surgeons (AAOS) now agree that 20950 (monitoring of interstitial fluid PRESSURE (includes insertion of device, eg, wick catheter technique, needle manometer technique)) is not billable per muscle group because any additional work to insert the catheter in different muscles of the same muscle group does not meet the requirements for individual reportage of 20950. “After considerable discussions with the coding committee of AAOS, they have provided the following guidance based on their belief that while per muscle would seem to be appropriate, the work required to install the catheter is limited and thus does not warrant reporting per muscle,” says an AMA spokesperson.

    They give this example on how these codes should be used.

    For instance, if your doc checks the four muscles in the leg, then you would only bill 20950 only once. However, if the doc measures the pressure in the thigh and leg you would report 20950 twice, and if the procedure was performed bilaterally, you could still bill 20950 twice by appending modifier -50 (bilateral procedure).
    I read this but I'm confused on something-- If the physician measures in the thigh and leg on each leg, can it be billed 4 times? Thanks for your feedback!
    Dicey

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