Wiki Spine & Ortho

[SA91]

Hi all!

Please may someone advise me on the following situation I have?

When we bill for any injection for instance 64490 cervical medial branch block there is for an example fee of $1000.00. So when I bill a bilateral one level cervical branch block it would look like this 64490 -RT & 64490 - LT totaling to $2000.00.

My question would be I would like to just bill 64490 with a 50 mod would insurance companies then automatically know that with the 50 mod it should be total $2000? Because on the bill it would read 64490- 50 fee $1000.00. Or should the provider change this fee for the 64490? I am curious what other offices do when they bill these injections?

Thank you,
Lisa.

 

[fltbaroque]

Hello Lisa,
When you bill one line with the 50 modifier, you should double the fee. This was confirmed at a recent Karen Zupko conference.

Tobi Chandler, CPC, CRC, CGIC

 

[SA91]

Hello Lisa,
When you bill one line with the 50 modifier, you should double the fee. This was confirmed at a recent Karen Zupko conference.

Tobi Chandler, CPC, CRC, CGIC

Hi,

Yes thank you I am aware that the fee needs to be doubled

 

[SharonCollachi]

Hi,

Yes thank you I am aware that the fee needs to be doubled

Wasn't that your question? Or was it something else?

 

[SA91]

Hi,

Yes thank you I am aware that the fee needs to be doubled

No I know that fees must be doubled for bilateral procedures. At the moment I am billing 28 procedures a day mostly bilat medial branch blocks and mostly 3 levels. I wanted to know if there was a easier way to do this so it is less time spent on billing. Here’s the thing, I was curious what other ortho offices do when given all these pain procedures and filing to insurances. To change the fee schedule and add 50 mod is also a lot of work.

 

[SA91]

Wasn't that your question? Or was it something else?

Please see my comment maybe that would be clearer

 

[SharonCollachi]

No I know that fees must be doubled for bilateral procedures. At the moment I am billing 28 procedures a day mostly bilat medial branch blocks and mostly 3 levels. I wanted to know if there was a easier way to do this so it is less time spent on billing. Here’s the thing, I was curious what other ortho offices do when given all these pain procedures and filing to insurances. To change the fee schedule and add 50 mod is also a lot of work.

Does your system not allow you to just override the fee without changing the actual fee schedule? When I'm billing something bilat, I type in the CPT code, hit tab, type the modifier, hit tab, and keep hitting tab until I get to the final fee (since I'm not changing units). I can override the fee there, for that one claim, just by typing it in. It truly doesn't take me any longer than it would typing in two units and hitting tab to get the doubled fee.

 

[SA91]

Does your system not allow you to just override the fee without changing the actual fee schedule? When I'm billing something bilat, I type in the CPT code, hit tab, type the modifier, hit tab, and keep hitting tab until I get to the final fee (since I'm not changing units). I can override the fee there, for that one claim, just by typing it in. It truly doesn't take me any longer than it would typing in two units and hitting tab to get the doubled fee.

I am doing it exactly that way and yes I can change my fee manually. I do a lot of claims in one day I always look for a easier and faster solution in the software system to make billing more efficient.

 

[SA91]

I am doing it exactly that way and yes I can change my fee manually. I do a lot of claims in one day I always look for a easier and faster solution in the software system to make billing more efficient.

For me this would be ideal... when adding mod 50 automatically a system would know to double the fee but that’s just me .

 

[csperoni]

That likely depends on your system AND how you have your system configured. The last 2 computer systems I used could do that, with configuration. You may want to contact your software vendor to answer this question.