Delaware Subscriber
Answer: From the information given, this procedure should be coded 62200-RT (ventriculocisternostomy, third ventricle; right side) and 62200-51-LT (... multiple procedures; left side) to indicate that separate craniotom-ies and fenestration procedures were performed on the left and right sides of the brain. Modifiers -LT and -RT are less confusing to many payers in this instance than modifier -50 (bilateral procedure). Because modifier -51 is attached to the second procedure code, payment for the left side may be reduced by as much as 50 percent.
For the diagnoses, include 348.0 (cerebral cysts) for the ventricular cysts and 331.4 (obstructive hydrocephalus) for the hydrocephalus.
The payer may initially reject the claim or request additional information, so keep documentation, including the operative report, ready, and be prepared to appeal.