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Thread: CPT 92226 modifer 50 or RT LT

  1. #1
    Join Date
    Apr 2007
    Posts
    22

    Default CPT 92226 modifer 50 or RT LT

    AAPC: CPC Promo
    Which is the correct way to code for 92226. Is one way preferred over another. Thanks in advance.

  2. #2
    Join Date
    Apr 2007
    Location
    Nashville AAPC Chapter
    Posts
    937

    Default

    You would have to check via payor preference rules as to whether they want mod-50 or LT/RT. Because this is a medicine code I would be tempted to bill LT or RT as the procedure would be paid at 100% for each procedure - but would be interested in other interpretations.

    Here is what supercoder says:

    These are unilateral procedures. If performed bilaterally, some payers require that the service be reported twice with modifier 50 appended to the second code while others require identification of the service only once with modifier 50 appended. Check with individual payers. Modifier 50 identifies a procedure performed identically on the opposite side of the body (mirror image).

    Here is MCR's instructions:
    The usual payment adjustment for bilateral procedures does not apply. If procedure is reported with modifier -50 or is reported for both sides on the same day by any other means (e.g., with RT and LT modifiers or with a 2 in the units field), base payment for each side or organ or site of a paired organ on the lower of: (a) the actual charge for each side or (b) 100% of the fee schedule amount for each side. If procedure is reported as a bilateral procedure and with other procedure codes on the same day, determine the fee schedule amount for a bilateral procedure before applying any applicable multiple procedure rules.
    Services in this category are generally radiology procedures or other diagnostic tests which are not subject to the special payment rules for other bilateral procedures.

  3. #3

    Default CPT 92226 OD/OS or LT/RT

    Which is the correct way to code for 92226. Is one way preferred over another. Thanks in advance

  4. #4

    Default

    We use -50 for Medicare and BCBS and -RT/-LT for any other insurance. Hope this helps

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