Cardiology Coding Alert

Question: How do you bill 36245-50 bilaterally? Does the 50 modifier tell them it was done twice on both sides? Do you bill it with two units or bill it twice. I am confused about how to demonstrate that each side was selectively injected.

Codify Subscriber

Answer: Bilateral reporting can be specific to the payer. Some will have policies stating to use a single line item with modifier 50 (Bilateral procedure) appended. This indicates the procedure was performed once on the left and once on the right. Other payers may ask you to report two line items with LT (Left side) appended on one line and RT (Right side) appended on the other.

But generally speaking, reporting 36245-50 (Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family) with 1 unit represents performing the service once on the left and once on the right, and is appropriate to indicate a bilateral service.

Note that 36245 has a bilateral indicator of 1 on the Medicare physician fee schedule. That means whether you use 50, RT/LT, or 2 units, the 150 percent payment adjustment applies.