Otolaryngology Coding Alert

Question: I read your ASC coding article last month with great interest and I have a follow-up question. We recently billed a bilateral ethmoidectomy (31255-50), and our Medicare payer only paid us a unilateral fee. Is modifier 50 not allowed in ASCs?


New Jersey Subscriber

Answer: Some payers will allow modifier 50 (Bilateral procedure) for bilateral surgeries that your otolaryngologist performs in an ambulatory surgical center. Other carriers require you to append modifiers LT (Left side) and RT (Right side) on separate lines.

Empire Medicare, a Part B payer in New Jersey, publishes a guideline that states, -For bilateral ASC procedures, the full wage adjusted rate will be allowed for the first procedure, and 50 percent of the wage adjusted rate will be allowed for the second procedure. An ASC procedure performed bilaterally in one operative session is reported as two procedures.

-Claims submitted by the ASC should not be reported with the 50 modifier to indicate that a procedure was performed bilaterally. The bilateral procedures should be reported on separate lines using an RT and LT modifier.- So if your surgeon performs bilateral ethmoidectomies in the ASC, report 31255-RT (Nasal/sinus endoscopy, surgical; with ethmoidectomy, total [anterior and posterior]) on one line and 31255-LT on the second line of your claim.