Ob-Gyn Coding Alert

Plus, know exactly where to go to find your code’s indicator.

The process of appending laterality modifiers to a surgical or radiological CPT^® code is more nuanced than what’s presented on the surface. In fact, one component of each surgical and ancillary CPT^® code that some coders tend to overlook is the bilateral surgery indicator.

Found within a code’s respective fee schedule, the bilateral surgery indicator assigns the code one of five categories that determines whether you may append modifiers RT (Right side), LT (Left side), or 50 (Bilateral procedure). Finding your code’s bilateral indicator is the easy part; understanding the nuances differentiating one indicator from another can be tricky without proper explanation.

Forge your path to bilateral coding success by breaking down the details of each bilateral surgery indicator.

Consider a Useful NCCI Analogy

You can think of the bilateral surgery indicator in the same context as a National Correct Coding Initiative (NCCI) modifier indicator. In the case of NCCI, your procedure-to-procedure (PTP) coding pair hinges on one of three modifier indicators that tell you whether it’s appropriate to bundle, bill together, or disregard the column 2 code. The idea is similar with bilateral surgery indicators. When you’re wondering whether you can bill a particular code with modifiers LT and RT or modifier 50, the code’s bilateral surgery indicator will reveal with the answer as follows.

Begin With Bilateral Surgery Indicator 0

A bilateral surgery indicator of “0” indicates that the concept of “bilateral” does not apply. This typically means that physiologically speaking, coding a left and right side is not possible. However, according to NGS Medicare, you will also see this indicator for codes in which “the code description states that this code is an existing code for a bilateral procedure.” Consider a vaginal biopsy code, such as 57135, such as 57135 (Excision of vaginal cyst or tumor). This code carries a bilateral surgery indicator of “0” because the vaginal canal is a singular anatomic site without a bilateral component. A bilateral surgery indicator of “0” also applies to ancillary services, such as 76830 (Ultrasound, transvaginal).

Get the Green Light With Bilateral Surgery Indicator 1

This indicator simply means that billing rules apply. When you see a code with a bilateral surgery indicator of “1,” and the physician performs the procedure bilaterally, submit the procedure on a single line with modifier 50. The code will be reimbursed at 150 percent of its Medicare Physician Fee Schedule (MPFS) value. For instance, modifier 50 would apply to code 58661 (Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy).

Use Caution With Bilateral Surgery Indicator 2

With bilateral surgery indicator “2,” the payment adjustment for bilateral procedures does not apply. You might be wondering how this indicator differs from a bilateral surgery indicator of “0.” When you see a code with bilateral surgery indicator “2,” the bilateral concept does not apply because the value of the code already factors the bilateral component into the equation.

Codes designated with bilateral surgery indicator “2” will typically describe the service as either “bilateral” or “unilateral or bilateral.” You will find plenty of these services within the gyn CPT^® codes such as 58565 (Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants), but none in the Radiology chapter of the CPT^® code book, with the exception of codes for mammography, such as 77067 (Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed).