Wiki 49505-50

[bosco]

Hi, can anyone advise on the correct way to code inguinal hernia when it is bilateral. Our coder first billed it on one line w/the modifier..that was denied. Then she billed it on two lines with modifier 50 on the second line...that was denied too. The insurance is Carefirst of Maryland.

thanks so much!

 

[mitchellde]

The correct way is one line with a 50 modifier with 1 unit of service, or as 2 lines one with an RT and one with an LT modifier. What did the denial state?

 

[bosco]

the denial states "these charges ere not billed using the agreed upon format, therefore, benefits are not available at this time."

I'll be happy to resubmit using LT & RT.

thanks!

 

[mitchellde]

the denial states "these charges ere not billed using the agreed upon format, therefore, benefits are not available at this time."

I'll be happy to resubmit using LT & RT.

thanks!

Odd denial... look in your contract and check the dx code they may have something in the contract or in the provider manual on how they want you to bill bilateral procedures. Some payers do have this.