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Modifier 50 - I am getting mixed information

  1. #1
    Default Modifier 50 - I am getting mixed information
    Medical Coding Books
    I am getting mixed information about what amount I should put in when billing for a bilateral procedure. For example 69436 Bilateral myringotomies and tube placement. If I am billing to carrier Anthem, would I enter the code on one line and use the modifier 50 and increase the billing fee to 150%? Some people are saying you would double the fee. I am unsure. Thank you

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default We double and take the adjustment
    Payers have different rules on how they handle this. So rather than changing our method for each payer, we always double the fee, and take the adjustment on the back end based on payment. (Of course, we DO check to be sure we were paid correctlyl for a bilateral procedure ....)

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Location
    Virginia Beach Local Chapter
    Posts
    997
    Default
    Quote Originally Posted by phillirk View Post
    I am getting mixed information about what amount I should put in when billing for a bilateral procedure. For example 69436 Bilateral myringotomies and tube placement. If I am billing to carrier Anthem, would I enter the code on one line and use the modifier 50 and increase the billing fee to 150%? Some people are saying you would double the fee. I am unsure. Thank you
    I agree with FTessa, We charge one fee to all carriers and adjust on the back side when needed. I find this to be the best way to bill as insurance info can change and you do not want to be billing a lower amount to one and a higher amount to another.
    Judy Wilson, CPC,COC,CPCO,CPPM,CPB,CPC-P,CPC-I,CANPC,AAPC FELLOW,CMRS

    Past AAPC-CA BOD 2010 - 2013 & 2015 - 2017


    judy@anes.hrcoxmail.com

    Nothing is impossible, the word itself says Im possible!
    -Audrey Hepburn

  4. Default
    We also double our fee for all carriers and make our adjustement on the back end.

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