Urology Coding Alert

The process of appending laterality modifiers to a surgical or radiological CPT^® code is more nuanced than what’s presented on the surface. In fact, one component of each surgical and ancillary CPT^® code that some coders tend to overlook is the bilateral surgery indicator.

Found within a code’s respective fee schedule, the bilateral surgery indicator assigns the code one of five categories that determines whether you may append modifiers RT (Right side), LT (Left side), or 50 (Bilateral procedure). Finding your code’s bilateral indicator is the easy part; understanding the nuances differentiating one indicator from another can be tricky without proper explanation.

Forge your path to bilateral coding success by breaking down the details of each bilateral surgery indicator.

Consider a Useful NCCI Analogy

You can think of the bilateral surgery indicator in the same context as a National Correct Coding Initiative (NCCI) modifier indicator. In the case of NCCI, your procedure-to-procedure (PTP) coding pair hinges on one of three modifier indicators that tell you whether it’s appropriate to bundle, bill together, or disregard the column 2 code. The idea is similar with bilateral surgery indicators. When you’re wondering whether you can bill a particular code with modifiers LT and RT or modifier 50, the code’s bilateral surgery indicator will reveal with the answer as follows.

Begin With Bilateral Surgery Indicator 0

A bilateral surgery indicator of “0” indicates that the concept of “bilateral” does not apply. This typically means that physiologically speaking, coding a left and right side is not possible. However, according to NGS Medicare, you will also see this indicator for codes in which “the code description states that this code is an existing code for a bilateral procedure.” Consider a prostate biopsy code, such as 55706 (Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance). This code carries a bilateral surgery indicator of “0” because since the prostate is a singular anatomic site without a bilateral component. A bilateral surgery indicator of “0” also applies to ancillary services, such as 74176 (Computed tomography, abdomen and pelvis; without contrast material).

Keep in mind that you will encounter other radiological services with a bilateral component that have a bilateral surgery indicator of “0,” as well — for instance, 73521 (Radiologic examination, hips, bilateral, with pelvis when performed; 2 views).

Get the Green Light With Bilateral Surgery Indicator 1

This indicator simply means that billing rules apply. When you see a code with a bilateral surgery indicator of “1,” and the physician performs the procedure bilaterally, submit the procedure on a single line with modifier 50. The code will be reimbursed at 150 percent of its Medicare Physician Fee Schedule (MPFS) value.

Use Caution With Bilateral Surgery Indicator 2

With bilateral surgery indicator “2,” the payment adjustment for bilateral procedures does not apply. You might be wondering how this indicator differs from a bilateral surgery indicator of “0.” When you see a code with bilateral surgery indicator “2,” the bilateral concept does not apply because the value of the code already factors the bilateral component into the equation.

Codes designated with bilateral surgery indicator “2” will typically describe the service as either “bilateral” or “unilateral or bilateral.” You will find plenty of these services within the Radiology chapter of the CPT^® code book, but few pertaining to urology. For a better understanding of when you might come across bilateral surgery indicator “2,” consider non-urologic codes ancillary codes such as 73050 (Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction) and 77047 (Magnetic resonance imaging, breast, without contrast material; bilateral).

Note Reimbursement Policy for Bilateral Surgery Indicator 3

While the other bilateral surgery indicators also include radiological services, bilateral surgery indicator “3” is exclusive to radiological services in which bilateral billing is allowed, but the reimbursement differs from that of services with a bilateral surgery indicator of “1.”

For services with a bilateral surgery indicator of “1” that are billed bilaterally, the first side is reimbursed at 100 percent of the fee schedule amount. However, the contralateral side is reimbursed at 50 percent of the fee schedule amount. This is the case when you submit with modifiers LT and RT. If you submit with modifier 50 for codes with a bilateral surgery indicator of “1”, the reimbursement amount is the same; however, the payer will reimburse for the single unit at 150 percent the fee schedule amount.

On the other hand, when you report a procedure code with a bilateral surgery indicator of “3” bilaterally, CMS will reimburse 100 percent of the fee schedule amount for both sides imaged. “Bilateral indicator ‘3’ is geared more toward CPT^® descriptors that do not contain laterality or complete versus limited information,” says Karyn Muerth, CPC, Coding Specialist at Radiology Regional Center in Fort Myers, Florida.

Steer Clear of Bilateral Surgery Indicator 9

Bilateral surgery indicator “9” means that the bilateral concept does not apply. You’ll want to distinguish this indictor from that of bilateral surgery indicator “0.” While an indicator of “0” may be assigned to surgical services where the bilateral concept doesn’t apply from a physiological perspective, an indicator of “9” is used for services that have no anatomic relevancy at all, such as moderate sedation code 99151 (Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports…). Under no circumstances can you bill this service bilaterally because the concept simply does not make sense within the context of the service.