Wiki 69210 modifier issue

[cdr4life]

Hello, I am needing some help with this please. i work for a PCP office in Arizona and am confused about what modifier(s) are appropriate for code 69210. I just saw for bilateral, it needs to be 69210-50. but we also have to add modifier 59 since it is a seperate service. Can we bill both modifiers if it is bilateral? Please let me know, any help would be appreciated.

Thank you,

Stephanie Garrison, CPC
Medical Biller and Coder
Good Health Financial, PC
4600 S. Mill Avenue, Ste 280
Tempe, AZ 85282-6850
Ph: (480) 305-2888 Ext 1131
Fax: (480) 305-2889
sgarrison@goodhealthfinancial.com

 

[1formissy]

The AMA and CMS disagree with the 69210. You can report it with modifier 50, even though in the description it indicates unilateral.
What else are you billing with the CPT code 69210?

 

[stephanie7480]

Yes you can append both modifiers. Append the 50 first and the 59 second.
If the payer is Medicare don't expect additional reimbursment for the bi-lat though.
http://blogs.aafp.org/fpm/gettingpaid/entry/medicare_turns_deaf_ear_to

 

[mitchellde]

Yes you can append both modifiers. Append the 50 first and the 59 second.
If the payer is Medicare don't expect additional reimbursment for the bi-lat though.
http://blogs.aafp.org/fpm/gettingpaid/entry/medicare_turns_deaf_ear_to

If the only procedure performed is the bilateral 69210 then you would use only the 50 modifier, however Medicare as well as other payers have decided to not be on board with recognizing the 69210 as a unilateral procedure so you will only be paid for one. You will not use the 59 in addition to the 50.