You Be the Expert: Left and Right Modifiers

Question: What is the correct use of left/right and finger/toe modifiers with emergency department (ED) procedures? We understand that these codes would be used only when the CPT indicates a specific paired organ or structure (i.e., closed reduction left humerus) not when the code describes a procedure that could be performed on multiple sites (i.e., laceration repair 3.0 cm left arm), because the code can also be used for the scalp. Is this the correct use of the modifier for APCs?

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Answer: These modifiers do not seem to apply to laceration repairs because multiple repairs of the same complexity are combined and reported as the total lengths, according to CPT guidelines. (The Health Care Financing Administration promised to further clarify the use of modifiers, so stay tuned.)

The HCPCS Level II modifiers are used when procedures are performed on paired organs and extremities (ears, eyes, nasal passages, kidneys, lungs, ureters and ovaries) and contralateral body areas (joints, bones) to prevent denial for duplicate services (which would not occur with the combined laceration lengths). You will be required to use the most specific modifier.

If more than one modifier applies, repeat the HCPCS code on another line of the UB-92 billing form and assign the next appropriate modifier. (26010* [drainage of finger abscess; simple], performed on the left thumb and second finger, would be billed 26010-FA on one line and 26010-FI on another line.) In another example, -E1 would be more appropriate for identifying a procedure on the upper left eyelid than -LT (left side).

Modifiers -RT/-LT (right side/left side) are required when a procedure is performed on one side and identifies the side operated on. You do not use modifiers -LT and -RT to report bilateral surgical procedures. Instead, use modifier -50 (bilateral procedure).

The source for You Be the Expert is Caral Edelberg, CPC, CCS-P, president of Medical Management Resources, an emergency medicine coding company in Jacksonville, Fla.


- Published on 2000-11-01