Wiki Bilateral code??

[jreed@parksoms.com]

Can anyone tell me if procedure code 21196 is assumed to be bilateral? We aways do this procedure as a bilateral procedure.

 

[ciphermed]

CPT code 21196 is inherently bilateral. A CPT Assistant indicates that the description was changed from ramus to rami, making the code inherently bilateral. The CPT code is also an Inpatient Only procedure for facilitiesl status indicator C.

Additional information indicates that if the procedure is performed unilateral; consider appending modifier -52.

Hope this helps,

 

[jreed@parksoms.com]

Thank You

 

[blfeitler]

Another validation I've used is the Medicare Physician Fee Schedule (RVU.) There is a column there for bilateral surgeries that lists status indicators. For 21196, the status indicator is "2", meaning that the RVUs are based on the procedure being performed as a bilateral procedure. I find this a good reference tool for validating information.