Radiology Coding Alert

Question: When can we append modifier 50 to bilateral X-ray claims?

New York Subscriber

Answer: If the X-ray code includes the word “Bilateral” in the descriptor, you should not add a modifier to show that the test is bilateral. You should know how to report the appropriate codes and modifiers when you do report a unilateral code bilaterally.

What is modifier 50? Modifier 50 tells the payer that the provider performed a unilateral procedure (described by a unilateral CPT^® code) bilaterally during the same session.

Consider this example: Code 73521 (Radiologic examination, hips, bilateral, with pelvis when performed; 2 views) includes the word “bilateral” and instructs you that you need two views of each hip to use the code. You should report 73521 without a bilateral modifier to indicate a bilateral service.

Check payer preferences: Although your payer may sometimes require you to use modifier 50 for bilateral claims, this is not true for all bilateral x-ray claims.

Medicare rule: Medicare typically requires you to report the relevant CPT^® code with modifier 50 on one line only.

Example: You report a bilateral 73620 (Radiologic examination, foot; two views) service to a payer requiring you to follow this one-line reporting rule. You would submit 73620-50.

List twice: Other payers may instruct you to list the procedure code twice and append 50 to the second code. If this were the case with the example above, you would report the following:

-   73620
-   73620-50

RT and LT modifiers: Still other payers want you to report the code twice, using modifiers RT (Right side) and LT (Left side). This is the most common method for reporting bilateral X-rays, such as the following:

-   773620-RT
-   773620-LT

Tip: Get your payers’ preferences in writing, and apply them every time.