Neurosurgery Coding Alert

Gain reimbursement for bilateral procedures with the correct modifier When a neurosurgeon performs a bilateral procedure such as a laminotomy, adding the correct modifier is key to showing the payer that the physician deserves additional compensation for the surgery. With the aid of Medicare's Physician Fee Schedule, you can be sure you-re getting the appropriate reimbursement. Refer to the Fee Schedule for Guidance Before deciding between modifiers 50 (Bilateral procedure) LT (Left side)/ RT (Right side) for a given claim, you should consult the 2006 Physician Fee Schedule database to see if appending a bilateral modifier is even allowable.
 
Look at column -T- of the spreadsheet, labeled -BILAT SURG.- If you see a -1,- you can use modifier 50 for that particular code and expect to receive 150 percent payment, says Barbara E. Oviatt, CPC, CCS-P, coding supervisor at Martin Memorial Medical Group in Stuart, Fla.
 
Here's how: Submit your claim with the code listed twice, once with modifier 50 and once without, and put modifier RT on one and modifier LT on the other. The payer should then process your claim and pay the neurosurgeon a total of 150 percent of the normal payment. But be sure to do this only with those few payers that process claims this way, because those that follow Medicare processing may pay you 150 percent on the one charge and 100 percent on the other.
 
-Medicare carriers for Part B services have published articles specifying their preference to report a bilateral service with a single line item with modifier 50 and 1 unit of service, whereas [some] non-Medicare payers prefer reporting bilateral services with two line items -- one with RT and 1 unit of service, and the second with LT and 1 unit of service,- says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting, a reimbursement consulting firm in Denver.
 
Example: Your neurosurgeon performs a bilateral lumbar laminotomy procedure (63030, Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar [including open or endoscopically assisted approach]). When you find this code in the Physician Fee Schedule database, you notice a -1- in column T, and therefore you should report the procedure as 63030-50. Avoid Bilateral Modifiers With -0- Indicator If you see a -0- in column T, you should not append modifier 50. -The -0- indicator means that the payment adjustment for bilateral indicator does not apply,- Hammer says.
 
Tip: You can use modifiers RT and LT for purely informational purposes when the physician does not perform services bilaterally, Hammer says. -For instance, a transforaminal epidural injection of the right L5 nerve could be coded as 64483-RT. This merely informs the payer that the [...]