Wiki bilat procedures

Create Wiki
J

jreilly12

Contributor
Messages
11
Location
Plattsburg, MO
Best answers
0
should bilateral procedures be coded with a modifier 50 or be separated out with the procedure codes having RT and LT with one having a modifier 59?
 
thank you this helps a lot are there any other ppl that are in this situation ... so basically if my practice is asking me to separate everything out like ear irrigation (69210) to me it should be charged as 69210 mod 50 and dx of H61.23 but they ask me to separate it as 69210-LT with H61.22 and 69210-RT-59 with H61.21. so is this insurance fraud or just a different way of doing things?
 
Fraud maybe not but Abuse maybe (Knowingly splitting claim in order to bypass payer edits). Per CPT parenthetical note for this code states:

(For bilateral procedure, report 69210 with modifier 50)

Also ICD-10 guidelines say when a combo code exists you need to use it

H61.23 is for bilateral impacted cerumen

So splitting it out violates CPT & ICD-10-CM guidelines
 
Last edited:
You must log in or register to reply here.
Top