Podiatry Coding & Billing Alert

Question: Our podiatrist recently removed lesions on both feet of a patient. Should we bill bilateral services for Medicare with modifier 50? What is the correct way to bill modifier 50?

Wisconsin Subscriber

Answer: For your given scenario, you should report from the codes 11055-11057 (Paring or cutting of benign hyperkeratotic lesion...) with RT (Right side [used to identify procedures performed on the right side of the body]) and LT (Left side [used to identify procedures performed on the left side of the body]) modifiers on two lines.

Medicare considers that Modifier 50 should be used only when a bilateral procedure is performed during one session and the Medicare Physician Fee Schedule Relative Value File (MPFSRVF), also known at the Medicare Physician Fee Schedule Database (MPFSDB) BILAT SURG indicator is 1 or 3. You should report codes that have a BILAT SURG indicator of 1 by appending modifier 50 and then submitting 1 unit of service on one line. You may also append the modifier to codes with a BILAT SURG indicator of 3 using 1 unit of service on one line. Ensure you are appending modifier 50 to report bilateral procedures performed during the same operative session by the same physician in either separate operative areas (feet/legs) or in the same operative area (e.g., nose).

Don't report modifiers LT and RT on the same service line when using modifier 50 to indicate a bilaterally performed procedure. Modifier LT or RT should be used only to identify one side of the paired organs operated on. You should stick to modifier 50 when reporting bilateral procedures. 

Common mistakes while billing modifier 50 include:

• Using modifier 50 when performing the procedure on different areas of the same side of the body.

• Appending modifier 50 when the BILAT SURG indicator is 0, 2 or 9.

• Use of modifier 50 when removing a lesion on the right foot and a separate lesion on the left foot. (RT and LT modifiers are correct here).

• Incorrect billing of a bilateral procedure on two lines of service by appending modifier 50 to the second line of service.