Radiology Coding Alert

Question: Why does code 73060 have a bilateral surgery indicator of “0?” Does that mean I should not bill for this service when the radiologist interprets imaging on both sides?

Massachusetts Subscriber

Answer: Contrary to some confusion, bilateral surgery indicator “0” does not mean you cannot bill bilaterally. Rather, it means that, when you do bill for a service designated with bilateral surgery indicator “0,” the Centers for Medicare & Medicaid Services (CMS) will not apply the typical 150 percent payment adjustment for a bilateral service.

Instead, CMS will base the payment for the two sides on the lower of the following outcomes:

•  “The total actual charge for both sides” or
• “100 percent of the fee schedule amount for a single code.”

CMS elaborates further with a helpful example:

• “The physician reports code XXXXX-LT with an actual charge of $100 and XXXXX-RT with an actual charge of $100. Payment should be based on the fee schedule amount ($125) since it is lower than the total actual charges for the left and right sides ($200).”

So, in the case of billing for 73060 (Radiologic examination; humerus, minimum of 2 views), the reimbursement depends on the payer. In most instances, you can expect payment to be based upon the fee schedule amount of one unit of 73060.