Wiki Question on Bilateral Facets/ Medicare

[bella2]

Hi,

There seems to be some confusion with billing for bilateral facets for Medicare. I was under the impression that in an ASC we are supposed to code with the RT/ LT Modifiers, for example bilateral L2-L3 Facet...
64475-RT
64475-LT.
But a coworker told me we are supposed to be coding one line with a 50 Modifier, 64475-50.
Any advice would be greatly appreciated as I will be getting my first audit with the company in Jan. 2010.

Thanks for all responses,
Bella

 

[Walker22]

My understanding is that ASC's are supposed to use the LT and RT modifiers, but physicians are supposed to use mod-50.Something about the way CMS processes ASC claims makes the mod-50 not work properly.. I don't really understand it to be honest.

 

[mcerlini]

I used RT/LT for medicare, so far there is no problem.

 

[mitchellde]

I have always used the 50 modifier as a one line item reporting in the ASC. I have looked under all the ASC reporting rules and nothing has ever indicated to not use the 50 in the ASC in fact it is just the opposite. Several writings do however state that some payers may express a preference for you to use the LT, RT modifiers as a double line reporting but this is a payer issue. So you can use the 50 in an ASC but it may be subject to payer issues but then again using RT, LT is also subject to payer issues.

 

[mbort]

Here is the link directly to CMS:

http://questions.cms.hhs.gov/cgi-bi...std_adp.php?p_faqid=9022&p_created=1205425194



I have always used RT/LT without issues.

 

[coderguy1939]

Exactly how we do them for Medicare--two lines with LT/RT modifiers.