Practice Management Alert

Question: Do I need always need to use modifier 50 when choosing a code to represent a procedure our provider performed on both sides of a patient’s body?

Ohio Subscriber

Answer: It may seem obvious, but the first thing you should do is “look at the CPT^® descriptor for the code to which you are thinking of appending modifier 50,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians. “If the descriptor includes the word ‘bilateral,’ you should probably not append modifier 50,” Moore cautions.

For example, “you can apply modifier 50 to 19303 (Mastectomy, simple, complete) if a patient had a double mastectomy,” says Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/ credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California. That’s because the service is not designated as bilateral, though it can be performed on an anatomic structure or organ that is symmetrical (like the nose or the cheeks) or that is paired (like the arms, legs, ears and, in the case of this mastectomy example, breasts).

“Another common mistake made by coders, which the note for modifier 50 in CPT^® Appendix A warns against, is appending modifier 50 to an add-on code. It should only be appended to base codes not otherwise labeled as bilateral and that are done bilaterally,” Moore advises.

Additionally, you should “check to see if there is any parenthetical instruction to use modifier 50 for bilateral procedures following the code in CPT®. If there is, that’s confirmation you can use modifier 50 with the code when the procedure is done bilaterally at the same session,” Moore adds.