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 [eg, for osteomyelitis or bone abscess]; mandible) has a medically unlikely edit (MUE) of two, so some coders say your best option is to bill two units. Remember, before reporting modifier 50 (Bilateral procedure), “bilateral” refers 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 third-party payers that recognize the X{ESPU} modifiers), to paint a clear picture of the service.

In the end, the coding choice will come down to the surgeon who performed the excision. Present the provider with the coding and modifier options, and work with them to determine which selection is most appropriate based on their knowledge of the procedure and the documentation.