# Modifiers -59 vs -50



## lindaskin (Mar 2, 2009)

When billing 21390 for both orbital floor blowout fractures, what modifier is appropriate?
According to Medicare the -50 modifier is not valid.


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## dmaec (Mar 2, 2009)

21390 has a status indicator of "0" in the bilateral column.  "0" means - bilateral surgery rules do not apply, do not use modifier 50.

how about RT/LT?


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## lindaskin (Mar 2, 2009)

lindaskin said:


> When billing 21390 for both orbital floor blowout fractures, what modifier is appropriate?
> According to Medicare the -50 modifier is not valid.


Is 21390 considered a unilateral or bilateral procedure?
We have tried using the LT & RT without success.


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## pamtienter (Mar 2, 2009)

Maybe try billing 2 units? I see Medicare allows 2 and so does UHC, so maybe others do too? 

http://www.cms.hhs.gov/apps/ama/lic...loads/Practitioner_DME_Supplier_MUE_Table.zip

https://www.unitedhealthcareonline....Policies/111308_MFD_CPT_Policy_List_09Q1A.htm


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## lindaskin (Mar 2, 2009)

Do you know anything about BCBS (IA)?


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## dmaec (Mar 2, 2009)

what's the exact denial reason they're giving you?


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## lindaskin (Mar 2, 2009)

too many services on the same day


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## dmaec (Mar 2, 2009)

hmm.. and that's the only code you're billing out?... is there a CCI Edit if you're coding out other codes with it?...


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## lindaskin (Mar 2, 2009)

no other codes billed with it


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## dmaec (Mar 2, 2009)

well, like bpct6501 said, you might try coding/billing it out with a x2 then, or the .51 or .59 modifier on the second one.  (since you already did the RT/LT)

hopefully someone else might have an idea on this...   sorry can't be of more help.


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## lindaskin (Mar 3, 2009)

we have tried billing on 2 lines and 1 with a 59 mod
we have also tried billing on 2 lines and 1 w/ a -51,LT mod & the other w/ just the RT
Is this CPT 21390 considered a bilateral already?


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## dmaec (Mar 3, 2009)

well, after a bit more research on the actual procedure itself - it does appear (at least to me) that there isn't a RT/LT or "bilateral" to this procedure - it is simply - the orbital floor (periorbital).
If I were you, I'd ask the surgeon exactly what it was, just to be sure that it isn't a RT/LT/50 procedure.

The description of the 21390 does not say bilateral (I'm thinking because there isn't a bilateral periorbital floor)


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## Robin R (Mar 3, 2009)

I've always billed with a 59:

21390-RT
21390-59,LT

Some insurers will deny but pay after I send a written appeal with the OP note.

I recently attended a Medicare webinar on modifiers (I'm in PA) & they suggested using the 76 modifier:

21390-RT
21390-76,LT

I haven't tried this yet so I don't have any experience with payment in this situation.


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## dmaec (Mar 3, 2009)

linda, when you find the answer - could you let me know what it is! !   I'd sure appreciate it.
thanks!


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