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Bilateral Procedure Question-I know this

  1. #1
    Default Bilateral Procedure Question-I know this
    Exam Training Packages
    I know this is a very basic question but I can't get a straight answer... is there one way that is accepted by Medicare, Medicare replacements, and commertial insurances to bill bilateral procedures? Every site I look at says something different.
    some examples are:
    92135 -50, 2 units, single charge $
    or
    92135 -50, 1 unit, double charge $
    or
    92135-LT, single charge
    92135-RT, single charge

    Are any of these ways universal???
    HELP!

  2. #2
    Location
    Tuscaloosa, AL
    Posts
    92
    Default
    It just depends on your carrier. Here in Alabama, Medicare wants xxxxx-50 with one unit and double price; Alabama Medicaid wants xxxxx-LT X 1 and xxxxx-RT X 1; most commercial carriers prefer xxxxx X 1 and xxxxx-50 X 1. And since they are paying they get to call the shots.

    Have fun.

    Jerri, CPC

  3. #3
    Default Bilateral Procedure Question
    According to Medicare, the application of the bilateral payment rule is dependent on the bilateral indicator on the Medciare Fee Schedule Database MFSDB).The bilateral payment adjustment does not apply to a procedure with 0,2 or 3 indicator and CPT 92135 falls under indicator 3. Do not use modifier -50, instead use RT, LT- on one line with (2) in unit column.

    Hope this helps.

    Nidhi M., CPC
    www.symbiosisbilling.com

  4. #4
    Default
    Thank you sooo much! But where do you find that information? (MFSDB)? Thanks again!

  5. #5
    Location
    North Carolina
    Posts
    3,126
    Default
    http://www.cms.hhs.gov/pfslookup/02_PFSsearch.asp

    Click on payment policy indicators and enter your information. This link provides the status indicator. The link below translates the definitions of those indicators.


    http://www.cms.hhs.gov/PhysicianFeeS...umPerPage=2000

    Under downloads, click RVU09C

    Open the PDF and go to pages 10-11 for bilateral.

  6. #6
    Default
    Perfect! Thanks!! This helps tremendously!

  7. #7
    Location
    St. Cloud, MN
    Posts
    58
    Smile
    This information is very helpful for all to review on a periodic basis for a refresher. We get so used to going through the motions, that it is good to reveiw and refresh. Thank you.

  8. Default Bilateral procedure question
    I have found this document helpful:
    http://www.lamedicare.com/provider/d...MODFLW2000.pdf

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