Radiology Coding Alert

Plus, know exactly where to go to find your code’s indicator.

Whether you’re working in the field of interventional or diagnostic radiology, it’s in your best interest to have a firm understanding of when and where you should be appending laterality modifiers to a given CPT^® code. As you’ll see, the rules may be different depending on if you’re tackling a diagnostic claim versus a surgical one, but the root principal always ties back to the concept of the bilateral surgery indicator.

Finding your code’s respective indicator is the easy part, but understanding the various nuances differentiating one indicator from another can be tricky without proper explanation.

Read further to break down the details of each bilateral surgery indicator.

Consider a Useful NCCI Analogy

You can think of the bilateral surgery indicator in the same context as you do a National Correct Coding Initiative (NCCI, or CCI) modifier indicator. In the case of NCCI, your Procedure-to-Procedure (PTP) coding pair hinges on one of three modifier indicators that tells you whether it’s appropriate to bundle, bill together, or disregard the column 2 code. The idea is similar with bilateral surgery indicators. When you’re wondering whether you can bill a particular code with modifiers LT (Left Side) and (Right Side) or modifier 50 (Bilateral Procedure), the code’s bilateral surgery indicator will reveal one of five options to work with. Have a look at each indicator, beginning with “0.”

Bilateral Surgery Indicator 0

The concept of “bilateral” does not apply. This typically means that physiologically speaking, coding on a left and right side is not possible. However, according to NGS Medicare, you’ll also see this indicator for codes in which “the code description states that it is an existing code for a bilateral procedure.”  Consider a surgical procedure on the heart, such as 33427 (Valvuloplasty, mitral valve, with cardiopulmonary bypass; radical reconstruction, with or without ring). A bilateral surgery indicator of “0” also applies to ancillary services, such as 71045 (Radiologic examination, chest; single view).

Keep in mind that you will encounter other radiological services with a bilateral component that have a bilateral surgery indicator of “0,” as well. For instance, have a look at 73521 (Radiologic examination, hips, bilateral, with pelvis when performed; 2 views).

Bilateral Surgery Indicator 1

Bilateral billing rules apply. When you see a bilateral surgery indicator of “1,” you may append the respective modifiers of LT and RT or 50 when the physician performs the procedure bilaterally.

Bilateral Surgery Indicator 2

The payment adjustment for bilateral procedures does not apply. You might be wondering how this indicator differs from a bilateral surgery indicator of “0.” When you see a code with bilateral surgery indicator “2,” the bilateral concept does not apply because the value of the code already factors the bilateral component into the equation. However, codes with a bilateral surgery indicator of “2” will be obvious when viewing the code description. You’ll typically see that the surgery or service is either “bilateral” or “unilateral or bilateral.” You will find plenty of these services within the Radiology chapter of the CPT^® manual. For instance, consider codes 73050 (Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction) and 77047 (Magnetic resonance imaging, breast, without contrast material; bilateral).

Coder’s note: You might have a hard time wrapping your head around the difference between indicators “0” and “2” given that both seem to include codes with “bilateral” in the code description. While the underlying rhyme or reason as to how each indicator is assigned may be unclear, the pricing for the bilateral service is factored into both code’s relative value units (RVUs). 

Bilateral Surgery Indicator 3

While the other bilateral surgery indicators also include radiological services, bilateral surgery indicator “3” is exclusive to radiological services in which bilateral billing is allowed, but the reimbursement differs from that of services with a bilateral surgery indicator of “1.”

For services with a bilateral surgery indicator of “1” that are billed bilaterally, the first side is reimbursed at 100 percent of the fee schedule amount. However, the contralateral side is reimbursed at 50 percent of the fee schedule amount. This is the case when you submit with modifiers LT and RT. If you submit with modifier 50 for codes with a bilateral surgery indicator of “1”, the reimbursement amount is the same; however, the payer will reimburse for the single unit at 150 percent the fee schedule amount.

On the other hand, when you report a procedure code with a bilateral surgery indicator of “3” bilaterally, CMS will reimburse 100 percent of the fee schedule amount for both sides imaged. “Bilateral indicator ‘3’ is geared more towards CPT^® descriptors that do not contain laterality or complete versus limited information such as breast ultrasounds (USs) and wrist X-rays,” says Karyn Muerth, CPC, Coding Specialist at Radiology Regional Center in Fort Myers, Florida. “For example, CPT^® code 73222 (Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s)) has the word ‘joint’ in its descriptor and there is a Medically Unlikely Edit (MUE) that states it can only be billed twice in one day,” explains Muerth.

Bilateral Surgery Indicator 9

Bilateral concept does not apply. You’ll want to distinguish this indictor from that of bilateral surgery indicator “0.” While you may append an indicator of “0” to surgical services where the bilateral concept doesn’t apply from a physiological perspective, an indicator of “9” is used for services that have no anatomic relevancy at all. For instance, consider moderate sedation code 99151 (Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports…). Here, you’re clearly able to determine that under no circumstances can you bill this service bilaterally because the concept simply makes no sense within the context of the service.