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Medicare 50 modifier

  1. Default Medicare 50 modifier
    Medical Coding Books
    I would like some one else in put please. I have coded a 11010 with a 50 modifier because it was done bilaterally, recieved a denial from medicare stating 50 modifier is not a valid modifier. can some one please help me with this. I am going back and forth with my superior and advising them that a 50 modifier is a valid modifer and she is telling me that it is not. If they have removed the modifier from the CPT book this is new to my knowledge if anyone else has information on this please let me know


    thanks
    LaTanya

  2. #2
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    Tacoma, WA
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    1,087
    Default
    Quote Originally Posted by lec121661 View Post
    I would like some one else in put please. I have coded a 11010 with a 50 modifier because it was done bilaterally, recieved a denial from medicare stating 50 modifier is not a valid modifier. can some one please help me with this. I am going back and forth with my superior and advising them that a 50 modifier is a valid modifer and she is telling me that it is not. If they have removed the modifier from the CPT book this is new to my knowledge if anyone else has information on this please let me know


    thanks
    LaTanya
    The 50 modifier is just not allowed with the 11010 code. So what you are saying is that there was bilateral fractures that required debridement? If that is the case, you will have to bill the same code twice and use a modifier 59 on the second procedure. You may have to appeal and send documentation to show why there was a need for bilateral debridement of open fractures.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. Default
    I took a coding class last spring. My instructor told me codes in the integumentary system cannot be bilateral. The skin is one organ. Make sure there is sufficient documentation to support two separate procedures. I hope this helps.

  4. Default modifer 50
    Hi ladies

    thank, you both, arlene, yes the patient is a double amputee and both areas needed debridement

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