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Bilateral HELP PLEASE

  1. #1
    Default Bilateral HELP PLEASE
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    Hello:
    What is the proper rule for all payers for bilateral procedures?

    Claim Line 1 - CPT code - 50 @ 1 unit OR

    Claim Line 1 - CPT code - 50 @ 2 units OR

    Claim Line 1 - CPT code - @ 1 unit and
    Claim Line 2 - CPT code (again) - 50 (1 unit)

    Any assistance would be greatly appreciated.

    Thank you,
    Cindy S. Cillo, CPC

  2. #2
    Location
    ENGLEWOOD/DENVER
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    good luck with this one. All payors have their own guidelines for bilateral. It wouldbe so much easier if they were all on the same page, but thats how they get away with what they do. They all have a different set of rules.

  3. #3
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    Greeley, Colorado
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    For one, it will depend on what CPT codes you are using. Radiology is different from "procedures". Here's what we do for bilateral joint injections without much trouble from the payers:
    Medicare and BCBS:
    20610 -50 x1 unit at 150% of the fee
    All others (for now):
    20610 -rt xt 1 at full fee
    20610 -50-lt x1 at 50%
    You don't need rt/lt, but I have found it helps.
    Lisa
    Lisa Bledsoe, CPC, CPMA

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