Urology Coding Alert
Consider Modifier Switch for Bilateral Billing of 1 MUE Codes
Tennessee Subscriber Answer: The bilateral surgery indicator of “1” indicates you can bill 54522 (Orchiectomy, partial) as a bilateral procedure. In this scenario, the obvious culprit may refer back to the code’s medically unlikely edits (MUEs). You’ll see that 54522 has a MUE of 1, which means that only one unit of 54522 may be submitted to the payer on a given date of service (DOS). Submitting 54522 on separate lines with modifiers LT (Left side) and RT (Right side) will cause a flag in the Medicare system for invalid CPT® code frequency. To override this denial, you must re-submit the claim as one unit with modifier 50 (Bilateral procedure) instead.
Urology Coding Alert
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