Neurosurgery Coding Alert

Question: We have been facing challenges for reporting bilateral procedures like injection codes 64483 (Injection[s], anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance [fluoroscopy or CT]; lumbar or sacral, single level) and 27096 (Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance [fluoroscopy or CT] including arthrography when performed). Is it better to report LT and RT modifiers or append modifier 50 (Bilateral Procedure)?

Illinois Subscriber

Answer: You can submit your bilateral procedures claims with one of the following:

1. Report procedure code on one line, write two in the units field, and use LT and RT modifiers
2. Report procedure code on two lines, write one in the units field, and use LT modifier in one line and RT modifier in another
3. Report procedure code on one line, write one in the units field, and report modifier 50

Make sure that the procedure that you are reporting meets the definition of bilaterality, i.e. it relates to two sides. Also note the CPT® and Medicare guidelines differ for use of the 50 modifier on claims. Whereas CPT® allows the use of the 50 modifier when billing for services provided bilaterally, Medicare uses the modifier 50 mainly for reimbursement purposes. According to Medicare, modifier 50 is only appropriate when the bilateral surgery indicator is "1" or "3". Medicare allows covered services at 150% of the Medicare Fee Schedule for the service codes that have an indicator of "1" and the service is provided bilaterally.

For such procedures, you report the procedure code once and append modifier 50 while reporting only one unit of service. However, the use of modifier 50 is not correct when your surgeon performs the service on different areas of same side of the body. Also, you do not append modifier 50 when the CPT® description for a procedure code mentions ‘bilateral’ in the descriptor. Finally, you should check to make sure that some payers may want you to report a bilateral procedure on two lines of service and append modifier 50 to the second line of service.