Pediatric Coding Alert

Question: How can we use our insurer's Fee Schedule to determine when we can report modifier 50 or modifiers RT and LT for procedures like wart removal (17000)?


Nevada Subscriber

Answer: If your insurer follows Medicare guidelines, you should check the Medicare Physician fee schedule's Column "T," which indicates whether bilateral services apply to each code.
 
Because the fee schedule's bilateral status indicator for 17000 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], all benign or premalignant lesions [e.g., actinic keratoses] other than skin tags or cutaneous vascular proliferative lesions; first lesion]) is "0," the 150 percent payment adjustment for bilateral procedures does not apply.

Therefore, you should report 17000 just once, followed by +17003 (... second through 14 lesions, each [list separately in addition to code for first lesion]) for each additional wart. You don't need to append a modifier such as 50 (Bilateral procedure) to either code. 

Other procedures, such as forearm splint application (29125), list a "1" in column T, which means you can append modifier 50 or modifiers RT (Right side) and LT (Left side), depending on which modifier combination your payer prefers. Therefore, if your pediatrician applies forearm splints to both the left and right arms, you can either report 29125-LT (Application of short arm splint [forearm to hand]; static) and 29125-RT, or you can simply report 29125-50.