Pulmonology Coding Alert

Modifier -50 can bring your practice 150 percent of the fee schedule amount You could be missing out on major reimbursement for bilateral claims if you're not clear about when to apply modifier -50 or the anatomical descriptors -LT and -RT.

Let us walk you through the do's and don'ts of the Medicare Physician Fee Schedule database to help you select the appropriate bilateral or unilateral designation with confidence. Turn to the Fee Schedule for Guidance Before you decide between modifier -50 (Bilateral procedure) and modifiers -LT (Left side) or -RT (Right side) for a given claim, you should consult the 2005 Physician Fee Schedule database, which is available on the CMS Web site at http://www.cms.hhs.gov/providers/pufdownload/rvudown.asp.

If you find a "1" in column "T" (labeled "BILAT SURG") of the fee schedule database, you can append modifier -50 to the code.

Example: Your physician inserts a temporary airway catheter into the right mainstem bronchus and another airway catheter into the left mainstem bronchus in a patient prior to bronchography. You should report this with 31710 (Catheterization for bronchography, with or without instillation of contrast material).

When you find this code in the fee schedule database, you'll notice a "1" in column T, and you can therefore report 31710 with modifier -50 attached to it because your physician performed a bilateral procedure.

You can expect most payers to reimburse bilateral claims at 150 percent of the assigned fee schedule amount, says Lisa Center, coding expert in Pittsburgh, Kan. -LT and -RT May Apply if Column T Lists a '0' A "0" in column T tells you that you cannot use modifier -50. You may report modifiers -LT or -RT, however, either in combination or singly, to make your claim more specific.

CPT added the anatomic-specific modifiers -RT and  -LT "to streamline the claims processing system, to allow for automated payment without having to request additional documentation to rule out duplicate or other inappropriate billing," according to the January 2000 CPT Assistant. Don't Expect to Use -50 or -LT/-RT With All Codes If there is a "1" in the fee schedule database's column T, you should append modifier -50, says Vicky O'Neil, CPC, CCS-P, coding and compliance educator in St. Louis, Mo.

A "0" in column T indicates that bilateral adjustment does not apply, either because of physiology/anatomy or because the code is unilateral and there is a different code for the bilateral procedure, coding experts say.

A "2" in column T of the database indicates that the code already specifies a bilateral procedure, so you  should not append a modifier to denote a procedure's bilateral nature.

Tip: Often, such codes will also specify "unilateral or bilateral" in their CPT descriptors.

Example: Your pulmonologist performs a bronchoscopy [...]