Anesthesia Coding Alert

Question: I recently had a denial for 22523-50. What did I do wrong?

Oregon Subscriber

Answer: Appending modifier 50 (Bilateral procedure) should not be reflexive. Remember there are CPT codes which already represent bilateral services, so you should not report modifier 50 with them.

Pain management coders see this with procedures such as kyphoplasty (22523, Percutaneous vertebral augmentation, including cavity creation [fracture reduction and bone biopsy included when performed] using mechanical device, one vertebral body, unilateral or bilateral cannulation [e.g., kyphoplasty] ...).

The code description indicates that these services can include either a unilateral or bilateral approach, so billing them with modifier 50 appended is incorrect and can lead to the quick denial.