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ASC Bilateral Codes

  1. Question ASC Bilateral Codes
    Medical Coding Books
    Hi,

    I'm looking for advice on billing out bilateral procedures in an ASC setting,in
    Florida, there seems to be so much confusion on the issue, I would really love to hear some opinions from other coders on this issue.

    Thanks in advance for all responses.

  2. #2
    Location
    Columbia, MO
    Posts
    12,837
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    You bill one line item with a 50 modifier and one unit of service and the single code charge.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    Hi Debra,

    Not to sound foolish but just to make sure I understand it properly,
    if patient had a bilateral arthroscropic rotator cuff repair, I should just report
    29827-50 ???

    Thanks for your help,

    Bella

  4. #4
    Location
    Columbia, MO
    Posts
    12,837
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    for facility coding I have always done it that way. Even for ASC. However in the physician world some carriers would have them do it as:
    29872 LT
    29872 RT

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Default
    Medicare wants two line items with Lt and Rt.

  6. #6
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
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    I agree with lgentry.

    I follow Medicare guidelines for all carriers to avoid confusion and do not have any problems with any payors.

    Per Medicare, the 50 Modifier is not valid in an ASC and you must use separate lines with RT/LT.
    Mary, CPC, CANPC, COSC

  7. #7
    Location
    Columbia, MO
    Posts
    12,837
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    Is it possible this is a regional issue with Medicare? Because I have just the opposite being stated here for Medicare as in do not use LT RT for bilateral. Isn't our job FUN!

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
    Location
    ENGLEWOOD/DENVER
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    2,338
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    Hmm I guess it could be, but here is the MLM from CMS directly

    http://www.cms.hhs.gov/MLNMattersArt...ads/SE0742.pdf
    Mary, CPC, CANPC, COSC

  9. Smile
    Thanks Mary, you're the best

  10. #10
    Default
    Quote Originally Posted by mitchellde View Post
    Is it possible this is a regional issue with Medicare? Because I have just the opposite being stated here for Medicare as in do not use LT RT for bilateral. Isn't our job FUN!
    i was told (in CA) that Mcare considers LT/RT as informational modifiers so in bilateral cases, i bill one line with the code and the 2nd line with -59 modifiers for both ASC and professional. All other insurances i use the -50 modifier or LT/RT.

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