Radiology Coding Alert

Documenting these details can make all the difference

Every coder knows that even the smallest details can sometimes make a big difference in your claims processing. Check for these two important notations when coding for bilateral procedures - one at the beginning of the process and the other at the end.

1. Determine the patient's initial diagnosis before the procedure. For example, if you report CPT 36245 -50 (Selective catheter placement, arterial system; each first-order abdominal, pelvic, or lower-extremity artery branch, within a vascular family; bilateral procedure), the documentation should list the appropriate initial diagnosis, such as 189.1 (Malignant neoplasm of kidney and other and unspecified urinary organs; renal pelvis).

2. Monitor reimbursement through your EOBs. Obtaining the correct reimbursement is often the biggest problem coders face when reporting procedures with modifier -50 (Bilateral procedure). Medicare pays 150 percent of the fee schedule when you use modifier -50 (you get full reimbursement for the first side and half reimbursement for the second). Some carriers might overlook the modifier and only pay for one side of the procedure, so verify that they're paying you correctly - and be sure you have the documentation to prove it when you appeal the claim.