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How best to report bilateral 20610 to Medicare

  1. #1
    Default How best to report bilateral 20610 to Medicare
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    One of my providers has given 20610 injections in both knees. How does Medicare want to receive these codes? These are the options I came up with:

    20610-RT x 1 unit
    20610-LT x 1 unit

    OR
    20610-50 x _ units? Would this be billed as 1 or 2 units? Any other modifier besides -50?

    I have not had to bill this procedure as bilateral before, whenever he has given more than one injection, there were two different joints with different codes (e.g. knee and elbow). I am rusty on appropriate use of modifier 50 since I rarely have to use it. Thanks.

  2. #2
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    I assume you are billing the professional fee (as opposed to a facility charge). If that is indeed the case, then you would bill like this:

    20610-50 x 1 unit

    Don't forget to bill the J code as well.
    Walker Bachman, CPC, CPPM

  3. Default
    Quote Originally Posted by kburke@hcbr.biz View Post
    One of my providers has given 20610 injections in both knees. How does Medicare want to receive these codes? These are the options I came up with:

    20610-RT x 1 unit
    20610-LT x 1 unit

    OR
    20610-50 x _ units? Would this be billed as 1 or 2 units? Any other modifier besides -50?

    I have not had to bill this procedure as bilateral before, whenever he has given more than one injection, there were two different joints with different codes (e.g. knee and elbow). I am rusty on appropriate use of modifier 50 since I rarely have to use it. Thanks.
    Hello,

    You do not want to use the 50 modifier with Medicare, there is some coding issues with the 50 . Medicare does not want 50 modifier. The way you had is the way you need to do it.
    Beware using 50 modifier with Medicare.

  4. Default
    I meant to say 20610/RT x 1 and 20610/LT x 1 unit and whatever drug is injected. I did not see that you typed a choice.

  5. #5
    Default
    Quote Originally Posted by nathalie1@cfl.rr.com View Post
    Hello,

    You do not want to use the 50 modifier with Medicare, there is some coding issues with the 50 . Medicare does not want 50 modifier. The way you had is the way you need to do it.
    Beware using 50 modifier with Medicare.
    I don't know where you get your information, but we bill 20610-50 to Medicare every single day, and have no problems at all.
    Walker Bachman, CPC, CPPM

  6. #6
    Location
    Columbia, MO
    Posts
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    I agree with Walker. In fact Medicare states that bilateral is a one line charge with the 50 modifier. There was a Medicare memo that came out regarding this in 2002.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Default
    Quote Originally Posted by mitchellde View Post
    I agree with Walker. In fact Medicare states that bilateral is a one line charge with the 50 modifier. There was a Medicare memo that came out regarding this in 2002.
    Thanks Debra and Walker for your responses.

    I am curious about how Medicare reimburses when the -50 modifier is used. The provider has essentially performed the same procedure two times. Is the Medicare allowed amount higher when the procedure has a -50 modifier than when it is filed without the modifier as a single procedure?

    Thanks,
    Kathy

  8. #8
    Default
    When a code is billed with a mod-50, the allowed amount is paid at 150% of the allowed amount. The code has to be eligible to be billed bilaterally (see RBRVS appendix) in order for this to be true, however. Not all codes are bilat eligible.
    Walker Bachman, CPC, CPPM

  9. Exclamation 20610
    Does anyone have any updates on this problem:

    I have billed as:

    1) 20610-50 x 1 unit
    20610 x 1 unit

    2) 20610-50 x 2 units

    3) 20610-50 x 1 unit (with the price of 2 showing on claim)

    All have been denied recently, I have a valid diagnosis so I know that is not the problem.

    Thanks

  10. #10
    Location
    Columbia, MO
    Posts
    12,560
    Default
    what does the denial state?

    Debra A. Mitchell, MSPH, CPC-H

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