Wiki Correct way to bill w/50 modifier? HELP!!!

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jdibble

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I have been trying to find the correct way to bill bilateral procedures. I have seen to bill Medicare one line with the 50 x 1 unit. When you bill this way are you supposed to correct the charge to twice the amount, 1 1/2 x the amount or keep the charge the same $ amount for the one unit?

I have also read that for other carriers we should bill 2 lines, the second line with the 50 modifier. If this is the case would I change the fees or bill the same amount twice? And would I need to add another modifier - such as 51 or 59?

If someone could help with this - I had been billing for an Urgent Care, but have now begun coding for General Surgeons, ENT and Ortho where they do alot of multiple procedures and bilateral procedures and I want to make sure I'm doing this right. I sent some charges to the billing dept for Aetna as the two lines with the 50 modifier and the supervisors didn't think this was right, so they changed the charges to two lines with RT and LT, no other modifiers and at the same $ amount on each line. I don't feel this is right. I would like to know which is right so that I can either code correctly or let my supervisors know what is right.

Thanks for any help! :eek:

Jodi Dibble, CPC
 
In my experience, you do not to need to agonize over this as much as you are. The dollar figure that you have associated with a CPT code is fictitious, and the insurance carriers pay what they pay. Bilateral procedures pay 1.5 times. Different carriers want to see bilateral procedures differently. -50 (try this first), -LT/-RT (try this second), -LT/-50-RT, x2 units, or a number of other variations. If you do not get paid properly, make the phone call. If you get denied, make the phone call. When you determine how to properly bill for a particular carrier, make a note of it, and always bill that way. Learn by trial and error.

Richard Mann, your pain coder
rkmcoder@yahoo.com
 
You can also check online...some carriers post their bilateral coding policies. From my experience - use one line item for Medicare, UHC and Blues:
20610-50 x1 150% fee
Others - use two lines:
20610 x1 100% fee
20610-50 x1 50% fee
Good luck.
 
correct way to bill w/50 modifier? HELP

On Medicare's website if you use the fee schedule look up for a specific code it. Click on the code and scroll down to the bottom. it will give you a number. click the question mark next to it and it will explain how that code should be billed either by 2 separate lines etc. if it is not Medicare then know how each insurance carrier prefers it or look at the contract you have with them.

i hope this helps.
 
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