Radiology Coding Alert

Question: When we report bilateral hip arthrograms using CPT 73525 -50, our carrier always reduces our fee for the second side, but we don't think they should take a reduction. Who is right?

Rhode Island Subscriber

Answer: You are. Many payers require practices to append modifier -50 (Bilateral procedure) to 73525 (Radiologic examination, hip, arthrography, radiological supervision and interpretation) when performing bilateral hip arthrograms, but some payers will automatically reduce your fee when the computer detects modifier -50 on a claim. Medicare carriers should not cut your reimbursement for the second side, so you should appeal this claim. If your payer does not require modifier -50, you should instead submit these claims with 73525-RT (Right side) and 73525-LT (Left side) or two units of 73525 to avoid unnecessary denials.

- The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Dallas, Ga; and Gary S. Dorfman, MD, FACR, FSIR, representative to the AMA's CPT Advisory Committee.