Otolaryngology Coding Alert

Question: One of our otolaryngologists wants to bill 21025 bilaterally with modifier 50, but this is not an appropriate modifier to use according to our coding system. He performed mandible resections on the right and left mandible. Would it be appropriate to file with modifier 59, or is this code considered bilateral?

West Virginia Subscriber

Answer: Code 21025 (Excision of bone [e.g., for osteomyelitis or bone abscess]; mandible) has an MUE of two, so some coders say your best option is to bill two units. Remember, before reporting modifier 50 (Bilateral procedure), “bilateral” refer to anatomic parts that are in pairs, such as arms, leg, or eyes. You have only one mandible, so it won’t quality for a bilateral procedure modifier.

Other coders recommend that, instead of billing two units, you include modifier 59 (Distinct procedural service) on your claim (or XS, Separate structure, for Medicare), and the second modifiers of LT (Left side) and RT (Right side) to paint a clear picture of the service.