Wiki Bilateral status indicator has changed again for CPT 64613 and 14?

[ollielooya]

For those of you who bill for this procedure, did you notice that change again in the 2012Physician Fee Schedule? Per 2011 directives of the 3rd(???) quarter we we advised that it could not be billed bilaterally and now it's back to allowing it again. Was this just a slip up somewhere? Have any of you received a response concerning this issue? ---Suzanne E. Byrum CPC

 

[ajs]

For those of you who bill for this procedure, did you notice that change again in the 2012Physician Fee Schedule? Per 2011 directives of the 3rd(???) quarter we we advised that it could not be billed bilaterally and now it's back to allowing it again. Was this just a slip up somewhere? Have any of you received a response concerning this issue? ---Suzanne E. Byrum CPC

That is strange..it shows in Encoder Pro that both codes are "Bilateral allowed" and in the modifier list for CMS the 50 modifier is allowed. But I could not find a publication stating that this position had changed from the previous notification.

 

[ollielooya]

So, Arlene, in your professional opinion does this signify a technical error and what would you do if you were in my shoes? Submit claims and utilize the modifier when appropriate or just wait? ---Suzanne

 

[ajs]

So, Arlene, in your professional opinion does this signify a technical error and what would you do if you were in my shoes? Submit claims and utilize the modifier when appropriate or just wait? ---Suzanne

In the 2012 National Physician Fee schedule that was released 11/1/2011 the codes 64613 and 64614 both have status 1 indicator for bilateral. So I would bill using the 50 modifier and expect the 150% payment. If you are denied I would submit the documentation from the CMS website showing the status indicator allows bilateral billing.