Oncology & Hematology 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 of 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 and indicate 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 to bill a particular code with modifiers LT and RT or modifier 50, the code’s bilateral surgery indicator will reveal the answer as follows.

Begin with Bilateral Surgery Indicator 0

A bilateral surgery indicator of “0” indicates 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 specifically states that it is a unilateral procedure and there is an existing code for the bilateral procedure.” Consider a prostate biopsy code, 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). Be sure when you enter the code with the modifier 50, your system automatically adjusts the fee for the procedure with the modifier added. If not, you may need to adjust the fee of the service as bilateral when appropriate.

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).

Note Reimbursement Policy for Bilateral Surgery Indicator 3

While the other bilateral surgery indicators also include radiological services, bilateral surgery indicator “3” are generally radiological or other diagnostic test services in which are not subject to the special payment rules for other bilateral surgeries with a bilateral surgery indicator of “1.”

Steer Clear of Bilateral Surgery Indicator 9

Bilateral surgery indicator “9” means the bilateral concept does not apply. You’ll want to distinguish this indictor from that of bilateral surgery indicator “0.” While an indicator of “0” may be assigned to surgical services where the bilateral concept doesn’t apply from a physiological perspective, an indicator of “9” is used for services that have no anatomic relevancy at all, such as moderate sedation code 99151 (Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports…). Under no circumstances can you bill this service bilaterally because the concept simply does not make sense within the context of the service.