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Wiki Bilateral Hips to MCR
- Thread starter alk@APS
- Start date
mitchellde
True Blue
in the MCM Mcare states to use the 50 modifier with 1 unit and one line for bilateral.
OCD_coder
True Blue
A little elaboration on why Medicare denied the 2nd hip.
When they applied the 50 to the primary code, they paid the base fee (should have) at 150%. So you got paid for line 1 for full 100% and then an additional 50% for the 2nd hip, which is all that you are entitled to. It's the same as getting the reducing the 2nd hip 50%.
It kind of messes with our coding process when we got denied for the 2nd procedure, but this is just how they have programmed their computer and how we should bill. Procedures that do not fall under the multiple procedure reduction rule (radiology) can be billed on two lines with RT and LT.
When they applied the 50 to the primary code, they paid the base fee (should have) at 150%. So you got paid for line 1 for full 100% and then an additional 50% for the 2nd hip, which is all that you are entitled to. It's the same as getting the reducing the 2nd hip 50%.
It kind of messes with our coding process when we got denied for the 2nd procedure, but this is just how they have programmed their computer and how we should bill. Procedures that do not fall under the multiple procedure reduction rule (radiology) can be billed on two lines with RT and LT.