Wiki 58661 and modifier 50

[psmedbill]

For a sterilization procedure our physicians do the procedure code 58661. They do a salpingectomy on both sides. I have been adding a modifier of 50 to this code? I know the code says that is it a bilateral code and is reported once even if the procedure is performed on both sides. Is this correct for me to do this? I have gotten different views on this. Some say yes it is ok because it is a sterilization and some say no because of what the cpt guidelines state. Please help me with coding this correctly.
Thank you so much in advance!!!

 

[sls314]

For a sterilization procedure our physicians do the procedure code 58661. They do a salpingectomy on both sides. I have been adding a modifier of 50 to this code? I know the code says that is it a bilateral code and is reported once even if the procedure is performed on both sides. Is this correct for me to do this? I have gotten different views on this. Some say yes it is ok because it is a sterilization and some say no because of what the cpt guidelines state. Please help me with coding this correctly.
Thank you so much in advance!!!

Modifier 50 is allowed with that code if a bilateral procedure is performed.

58661 is listed on the Medicare physician fee schedule with a Bilateral Indicator of "1." (If a procedure cannot be billed with a Bilateral modifier, CMS uses a Bilateral Indicator of "9.")

Also, this is the verbiage from EncoderPro's Coding Tips:

This is a bilateral code and is reported once even if the procedure is performed on both sides according to CPT instructions. Surgical laparoscopy always includes diagnostic laparoscopy. For diagnostic laparoscopy only, see 49320. If the procedure is performed to treat an ectopic pregnancy, see 59151. When 58661 is performed with another separately identifiable procedure, the highest dollar value code is listed as the primary procedure and subsequent procedures are appended with modifier 51. Medicare instructions allow the reporting of modifier 50 when performed bilaterally. Check with individual payers for their instructions. To report open salpingectomy, see 58700; for open salpingo-oophorectomy, see 58720. If a hysteroscopy is performed in conjunction with this procedure, report the appropriate hysteroscopy code.



Of course, there could be commercial payers who want it billed another way, but you'd be getting denials from those payers if they didn't like the modifier you billed.

 

[csperoni]

Seconding @sls314
While per Medicare guidelines, -50 is appropriate if done bilaterally, in the real world:
1) Some carriers want -RT and -LT not -50
2) Some carriers don't care if it was bilateral or not and will only pay 100% of 1 unit.