Internal Medicine Coding Alert

Question: I need some information on billing bilateral procedures. For Medicare, should I report the code only once with modifier 50 using a quantity of one or two on the first line? If so, would I double the fee from $1.00 to $2.00?

Oregon Subscriber

Answer: Medicare generally wants you to use only one line with modifier 50 (Bilateral procedure) and a quantity of one.

Example: An IM removes a splinter using a needle from each foot (28190, Removal of foreign body, foot;subcutaneous). When you look up 28190 on the Medicare Physician Fee Schedule, you find the code has a bilateral procedure indicator of 1, meaning the code is eligible for bilateral reporting using modifier 50.

Caution: Do not double the fee. Medicare already pays codes appended with modifier 50 at 150 percent; doubling the fee to $2.00 from $1.00 would push the payment to 300 percent and be inappropriate.