Radiology Coding Alert

Question: I have been looking at examples showing how to code angiograms, and I noticed that there are right and left modifiers on radiology procedures even if they aren't specific to one area. Aren't these left and right modifiers only supposed to be used if the procedure is specific to one area? 

Rhode Island Subscriber

Answer: You could correctly use the left (-LT) and right (-RT) modifiers in the situation you describe - and these modifiers present an interesting case in learning how to avoid denials. 
 
Let's consider the example of a procedure done on both the left and right renal arteries. An angiogram occurs when a doctor inserts a catheter into the blood vessel, injects x-ray dye (contrast), and takes x-rays. The procedure for both renal arteries is coded 36245 (Selective catheter placement, arterial system; each first-order abdominal, pelvic, or lower-extremity artery branch, within a vascular family). If you don't add the left and right modifier to signal that both were involved, one could be denied as a duplicate.
 
Some payers prefer modifier -50 (Bilateral procedure) for a truly bilateral structure like the renal arteries. In this case, append -50 to the surgical code the second time you report it (36245, 36245-50). Another payer might want you to append modifier -59 (Distinct procedural service) the second time you list the surgery code. 
 
Most Medicare carriers prefer you not to use modifier -51 (Multiple procedures), because they generally assign it themselves during processing.
 
There may be exceptions. Non-Medicare payers will have their own preferences about this modifier. It relates to the performance of multiple services, so be sure you append -51 to the second service and those that follow.