Anesthesia Coding Alert

Clue: Start with the descriptor.

Pain management providers performing bilateral procedures is not uncommon. Experienced coders know, however, to not jump to conclusions and automatically append modifier 50 (Bilateral procedure) to the procedure code.

Here’s why: Some procedure descriptors already allow for bilateral procedures, which means modifier 50 probably is not necessary.

“Look at the CPT^® descriptor for the code to which you are thinking of appending modifier 50,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians. “If the descriptor includes the word ‘bilateral,’ you should probably not append modifier 50.”

You can apply modifier 50 to a code when the service is not designated as bilateral, though it can be performed on an anatomic structure or organ that is symmetrical (like the nose or the cheeks) or that is paired (like the arms, legs, or ears), according to Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/ credentialing/ auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California.

Example 1: Code 64612 (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm)) is established as a unilateral service, but the provider could perform the procedure bilaterally in some circumstances. If you have documentation supporting that, you can append modifier 50 to code 64612.

Example 2: The descriptor for code 20526 (Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel) does not mention either type of laterality. If you have documentation that the provider administered injections to both sides of the carpal tunnel on the same hand, you can include modifier 50 on the claim.

But: “Another common mistake made by coders, which the note for modifier 50 in CPT^® Appendix A warns against, is appending modifier 50 to an add-on code. It should only be appended to base codes not otherwise labeled as bilateral and that are done bilaterally,” Moore advises.

Additionally, you should “check to see if there is any parenthetical instruction to use modifier 50 for bilateral procedures following the code in CPT®. If there is, that’s confirmation you can use modifier 50 with the code when the procedure is done bilaterally at the same session,” Moore adds.