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Thread: cpt code 15734 with mod 50

  1. #1
    Join Date
    Apr 2007
    Posts
    18

    Default cpt code 15734 with mod 50

    can you bill cpt code 15734 with modifier 50 if this was done bilaterally, or should the cpt code be billed out twice?

  2. #2
    Join Date
    Apr 2007
    Location
    Milwaukee WI
    Posts
    4,453

    Default Skin is not lateral

    Other than those codes specific to breast surgery, the codes in the integumentary system cannot use the bilateral modifier.

    F Tessa Bartels, CPC, CEMC

  3. #3

    Default

    This procedure cannot be billed with 50 modifier
    Regards..,
    Nandha CPC

  4. #4

    Default CPT 15734-50 okay

    According to the American College of Surgeons (see Socioeconomis Tips Volume 94) http://www.facs.org/ahp/pubs/tips/tips1109.pdf, they advise to use 15374-50 if both sides are mobilized.

  5. #5
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    11,883

    Default

    I think they have the phrasing incorrect. If the hernia repair were on both sides you would append a 50 to the hernia repair and that is correct, however the flap has no laterality and can only be billed twice if in fact two separate flaps were taken and use the 59 modifier to show separate site.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6

    Default 15734

    Your procedure will reject out if you use the 50 modifier as the previous post states. But if you use the 59 modifier it will pay. My general surgeon does myocutaneous muscle flaps alot, and we always use 59 modifier when the documentation specifies the flaps were in two separate areas.

  7. #7
    Join Date
    Apr 2007
    Location
    Kingsport,TN
    Posts
    11

    Default 15734

    How do you bill for a ventral hernia repair when the surgeon has done a left and right rectus release and brought the bectus back to the midline for good coverage. It was decided to use a piece of biologic mesh 25x20 piece of HC Flex mesh was used. Do you bill 15734, 15734/59 49560 and 49568?

  8. #8
    Join Date
    Apr 2007
    Location
    Atlanta Perimeter
    Posts
    59

    Default

    We bill 15734 with modifiers RT and LT to Medicare, we bill 15734 and 15734-59 to Secure Horizions, 15734-50 to Amerigroup, while care improvement plus wants both lines of 15734 to have modifier 59. We have called or in some way contacted these companies to get guidance on this, it is really based on the payer here. Hite, I would say yes your coding is correct, if thats how your payer wants it.
    Erica Reno, CPC

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