Wiki 52005 bilateral vs RT LT

[RCOX]

Urologist preforming 52005 bilaterally.
The modifier 50 has been omitted this year in the AAPC CPT book for 52005.
Previous forum, dated 2007, indicated that it is inappropriate to bill 52005-RT AND 52005-LT together.
Why and where can I find this information?

 

[BenCrocker]

When using my CPT manual there's no note saying you can't use 50 or LT/RT.

Most recent CPT 2015 from the AMA.

 

[nateich]

Per Optum Coding Companion 2015 Urology/Nephrology -50 cannot be used on 52005; when our physicians perform bilaterally we bill 52005 with 2 units which is allowed; in some cases it is paid and other times it is not.

 

[emcee101]

Medicare does not allow bilateral reimbursement for this CPT code. The bilateral surgery indicator (noted on the CMS MPFSRVF file) for CPT code 52005 is "0" which means that the 150% payment adjustment for modifier 50 does not apply. Here a little info from one of the CMS MACs, WPS.

http://www.wpsmedicare.com/j5macpartb/resources/modifiers/modifier50.shtml

As noted previously, some commercial carriers may pay for this procedure to be billed with a 50, or with LT and RT on two different lines, or with 2 units. The correct way to bill for this will probably vary by carrier preference.