Wiki Help with CPT code 92604

[green69elephant]

Hi everyone, I really need help with this code 92604. I have a Dr. billing this code twice on the claim with a modifier 59 on one line. I have two questions about this claim. The first question I have is this a Unilateral proc code or a Bilateral proc code. I have found conflicting info on the internet that says it should be billed once with a modifier 22 for the extra work. Some say it should be billed twice with a LT and RT or once with a modifier 50. Can anyone shed some light on this code? I have a nurse who is saying this code is appropriate to be billed twice with a mod 59.

 

[SharonCollachi]

There is some info here in this thread.

 

[b.cobuzzi]

This is a unilateral code. It is for one cochlear implant. But there is no option to bill this bilaterally. So, if the subsequent programming is performed on two sides, on to implants, this would have to be billed on two lines. The second line should have an XS modifier for all payers that recognize the X[ESPU] modifiers or a 59 modifier for any payers that do not recognize the X[ESPU] modifiers.

I like using side modifiers also, so it would be billed:
92604-RT
92606-XS-LT Or 92604-59-LT

Practices should use the X[ESPU] whenever a payer recognizes these modifiers as use of the 59 modifier can put the practice in a red flag compliance position since overriding bundles is a common fraudulent billing practice. Using the X[ESPU] modifiers shows you checked the documentation and can justify why the service is a Distinct Procedural Service.