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How best to report bilateral 20610 to Medicare

  1. Exclamation 20610
    Medical Coding Books
    The first 2 say are denial code M86 - Service denied because payment already made for same/similar procedure within set time frame.

    3rd denial states ti submit as a new claim electronically not as an appeal then when that was done it was denied as a duplicate.

    What is the correct way of billing two 20610 in one visit with a valid diagnosis code?

    Thank you for your help.

  2. #12
    Columbia, MO
    when billing Medicare as well as most other payers it is
    20610 50 with 1 unit of service and the single code charge.
    that is if the procedure was performed bilateral, If the procedure was performed say on the right shoulder and right hip then it would be
    20610 rt
    20610 59 rt
    if it was performed on the right hip and the left shoulder it would be
    20610 rt link to dx 1
    20610 lt link to dx 2
    the denial suggests that there is a prior encounter for an injection of the same area within too close a timeframe to the current billed encounter. Is this possible?

    Debra A. Mitchell, MSPH, CPC-H

  3. #13
    Minneapolis MN
    Medicare's CCI edits indicate that we can bill 20610 with a -50 modifier. We bill on one line with 20610-50 with one unit and the price 1.5x. Seems to be working for us.

  4. Smile
    Thank you Deborah and Gailmc for your help!

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