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Renal angio; Bilateral - HELP

  1. Default Renal angio; Bilateral - HELP
    Medical Coding Books
    Hello all. When we code 36245 and the procedure is Bilateral, my new coder is using the 50 modifier and changing the units from 1 to 2. Is that really necessary? Doesn't the 50 modifier already say that it's bilateral and all she should really be doing is changing the price to reflect the cost x 2 but not really changing the units?? One of the insurance companies paid triple what they should have. I'm not complaining about the overpayment, I just want to code correctly.

  2. Default
    Reporting 36245 -50 x 1, indicates a bilateral procedure. It seems inappropriate to report 36245 -50 x 2 for a bilateral renal angiogram; hence the "overpayment".

    If 36245 -50 x 2 was reported to Medicare on a hospital claim, it would generate a billing edit; OCE 74 Units Greater than one for bilateral procedure billed with modifier -50

    Hope this helps,
    Anthony McCallum, CPC, CIRCC, CPC-I, CCS
    ciphermed@optonline.net

  3. #3
    Default Billing manager
    Definition
    Bilateral procedure performed at the same session on an anatomical site.
    Appropriate Usage:
    When the procedure is done bilaterally AND the MPFSDB indicator for the procedure is "1" or "3" report the procedure code once; append with modifier 50 and report with one unit of service.

    Appropriate use occurs when the performing services on two bilateral body parts.

    Inappropriate Usage:

    Reporting this modifier when the performing the service on different areas of the same side of the body.

    The BILT SURG indicator is 0,2 or 9.

    When removing a lesion on the right arm and one on th left arm.

    On a procedure code that is described as a Bilateral in its CPT Description.

    Do not report a bilateral procedure on two lines of service and append modifier 50 to second line of service

    ADDITIONAL INFORMATION:
    WHEN SUBMITTING MODIFIER 50 APPROPRIATELY mEDICARE'S REIMBURSEMENT FOR THE SURGICAL PROCEDURE IS 150 PERCENT OF THE FEE SCHEDULE.

    CORRECTLY BILLED FOR BILATERAL PROCEDURE: THE PROCEDURES AND MODIFER 50 WITH UNIT OF 1 WILL PAY AT 150 PERCENT OF THE FEE. THIS IS FOR MEDICARE.
    Last edited by deb9645; 03-18-2010 at 01:30 PM.

  4. Default
    thank you for having my back!!

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