Wiki 30465-52

[efuhrmann]

when coding procedures using highest to lowest RVU as the guide to order, where do I put 30465-52? Do I use the RVUs for bilateral or half of that for unilateral?

 

[mitchellde]

I do not have my book at the moment but is that the code for repair of vestibular stenosis? If so there is no bilateral designation to my recollection.

 

[efuhrmann]

In the CPT 2010 book, in the parenthetical remarks, it states "30465 is used to report a bilateral procedure. For unilateral procedure, use modifier 52".

 

[mitchellde]

Ah I see that now that I have my book. So the quest is how to list it. I have a couple of examples for you same scenario two different payers. One it did not matter how it was listed the payer paid the procedure without the 52 at 100% and discounted the one with the 52. Second one was sent first with the procedure with the higher RVU listed second first with the 52 modifier. They discounted both procedures. It was resubmitted as a corrected claim with the order reversed and they paid correctly. The payer in the first example was BC/BS and the second was Medicare. I hope this helps

 

[efuhrmann]

Yes that helps-thank you for the information. Anymore these issues seem to depend on the payer, the day of the week, the phase of the moon...