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Bilateral Policy - UHC

  1. #1
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    Long Island/New York
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    Default Bilateral Policy - UHC
    Medical Coding Books
    anyone know of this UHC bilateral policy? My Dr did a 20680 on both legs...soooooooooooooo we billed out 20680-50. UHC denied on their bilateral policy. When I was directed to their website and found their list of "accepted" codes that can be bilateral - 20680 was NOT on the list.

    Has anyone dealt with this and if so - how did you get paid. My Dr is not going to accept a well-used code 20680 to be denied since he did it on 2 limbs!!

  2. Smile Bilateral procedure...
    First, GO YANKEES!!! I am a transplanted New Yorker and I love the Yankees!

    When I was billing Orthopaedics, depending on the carrier preference, we either billed 20680-RT and 20680-LT...OR...20680 and 20680-59. It is pretty safe to say that they will cut the second procedure by half but we have no control over that part of it.

    Good luck!

    Joyce

  3. #3
    Location
    Greeley, Colorado
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    2,045
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    20680 is not billable with -50 because it is not necessarily a bilateral code. Mod -59 would be appropriate since the implant(s) removed could be from the rt knee and the rt ankle or rt knee and lt knee, etc... You are going to have to show that the implants were removed from separate locations rather than simply bilateral.
    Lisa Bledsoe, CPC, CPMA

  4. #4
    Location
    Long Island/New York
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    Quote Originally Posted by Lisa Curtis View Post
    20680 is not billable with -50 because it is not necessarily a bilateral code. Mod -59 would be appropriate since the implant(s) removed could be from the rt knee and the rt ankle or rt knee and lt knee, etc... You are going to have to show that the implants were removed from separate locations rather than simply bilateral.
    it was taken from right & left femur - which I explained. But they state their "policy" is this is a code that won't be paid as a bilateral procedure. I will resubmit with documentation and see what happens. Thanks. Never ends with insurance companies!!

  5. #5
    Location
    Greeley, Colorado
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    2,045
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    My point is that even though yours was right and left it isn't always the case with implant removals, so they don't recognize it as a bilaterlly billable procedure, rather as a separate procedure. I know what you are saying though. It would be oh so nice if the rules were the same for everyone. Good luck!
    Lisa Bledsoe, CPC, CPMA

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