Urology Coding Alert

Question: My urologist performed a bilateral trans-scrotal testicular fixation without a testicular torsion reduction. Should I be billing CPT 54620 times two, or should I use modifier 50?

Oklahoma Subscriber

 Answer: You're correct that the basic procedure code you should use is 54620 (Fixation of contralateral testis [separate procedure]). When dealing with non-Medicare payers, you should ask your insurers how they want you to report bilateral procedures -- whether to use modifiers 50 (Bilateral procedure), LT/RT (Left/Right side), or both together.

Some insurers will specify when they prefer modifier 50 and when they require modifiers LT/RT. Other payers prefer modifiers LT/RT in all circumstances because they think those modifiers are more specific than modifier 50.

Even when requiring modifier 50, some payers have different ways that they want you to report the services. Some carriers might prefer you to report your procedure code using two line items, appending modifier 50 to the second code (such as 54620, 54620-50). Other carriers might want the code reported only once, with modifier 50 appended (such as 54620-50).

Protect yourself: Always be sure to get the payers' coding recommendations and payment guidelines in writing in the event of audits or claim reviews, coding experts say.