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Medicare Compliance & Reimbursement

MODIFIERS:

Don't Get Burned by Bilateral Modifier Guidelines

Published on Sun Aug 02, 2009

Number '2' in column Z? Strike out modifiers 50, RT, LT as options. Not sure if you can apply a modifier when your physician performs a bilateral procedure? Leaving the modifier off could cancel out additional compensation your physician deserves for the surgery. Check out these sure-fire ways you can determine if a particular code allows a bilateral modifier. Scenario: Your doctor performs a complete pelvic lymphadenectomy (38770, Pelvic lymphadenectomy...) on both sides, and you're not sure what modifier(s) to use. What should you do? Before deciding between modifiers 50 (Bilateral procedure), LT (Left side), or RT (Right side) for a given claim, you should consult the Physician Fee Schedule database to see if a bilateral modifier is allowed (www.cms.hhs.gov/pfslookup). Look at column Z of the spreadsheet, labeled "BILAT SURG." If you see a "1," you can use modifier 50 for that code and expect to receive 150 percent [...]
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