Wiki Using Laterality Modifiers with ICD-10

[kravpa]

Does anyone know if when we are using an ICD-10 code that specifies laterality, do we still need to use the LT/RT modifiers to append the CPT code? Or is the ICD-10 code sufficient as IT says where the injury etc... is located?

Thank you for your feedback,
Jackie K

 

[mhstrauss]

Does anyone know if when we are using an ICD-10 code that specifies laterality, do we still need to use the LT/RT modifiers to append the CPT code? Or is the ICD-10 code sufficient as IT says where the injury etc... is located?

Thank you for your feedback,
Jackie K

I don't have any official references available, but this has been discussed in a few other forums here. I believe the general consensus is that the laterality modifiers should still be used, even though the ICD10 code will indicate left or right. If anything, it could give a payer a reason to deny, IF the modifier and ICD10 don't match.

 

[lgardner]

I don't have any official references available, but this has been discussed in a few other forums here. I believe the general consensus is that the laterality modifiers should still be used, even though the ICD10 code will indicate left or right. If anything, it could give a payer a reason to deny, IF the modifier and ICD10 don't match.

that is correct.
we will still use the laterality modifiers with ICD-10 (at least for the moment).


per CMS:

"When ICD-10-CM codes replace ICD-9-CM codes on October 1, 2015, it will not impact how you report CPT and HCPCS codes, including CPT/HCPCS modifiers for physician services. While ICD-10-CM codes have expanded detail, including specification of laterality for some conditions, you should continue to follow CPT and CMS guidance when you report CPT/HCPCS modifiers for laterality."

here is the link to the publication:
https://www.cms.gov/Medicare/Coding/ICD10/downloads/ICD-10Overview.pdf

 

[mhstrauss]

that is correct.
we will still use the laterality modifiers with ICD-10 (at least for the moment).


per CMS:

"When ICD-10-CM codes replace ICD-9-CM codes on October 1, 2015, it will not impact how you report CPT and HCPCS codes, including CPT/HCPCS modifiers for physician services. While ICD-10-CM codes have expanded detail, including specification of laterality for some conditions, you should continue to follow CPT and CMS guidance when you report CPT/HCPCS modifiers for laterality."

here is the link to the publication:
https://www.cms.gov/Medicare/Coding/ICD10/downloads/ICD-10Overview.pdf

Thanks for the link!

 

[kravpa]

You guys rock!

THANK YOU FOR ALL THE GREAT INFORMATION~!

Jackie

 

[chembree]

It really makes sense to have to use CPT modifiers still when you think about it. The CPT code describes the side of the body the exam or procedure is performed on and the diagnosis describes the side of the body affected by a condition.
As an example, an exam may be of the left breast but the patient may have right breast cancer with pain in the left breast. In this situation the exam would have a LT modifier but the cancer diagnosis would be of the right breast. The CPT modifiers serve a separate purpose than the diagnosis laterally.

 

[scottporter777]

Updates?

Are there any updates to this thread information since 2007?

 

[CodingKing]

Are there any updates to this thread information since 2007?

No change. There will never be a change. Its even more necessary now since the guidelines have been clarified that bilateral dx code may be needed even when treating one side of the body.

When a patient has a bilateral condition and each side is treated during separate encounters, assign the "bilateral" code (as the condition still exists on both sides), including for the encounter to treat the first side. For the second encounter for treatment after one side has previously been treated and the condition no longer exists on that side, assign the appropriate unilateral code for the side where the condition still exists (e.g., cataract surgery performed on each eye in separate encounters). The bilateral code would not be assigned for the subsequent encounter, as the patient no longer has the condition in the previously-treated site. If the treatment on the first side did not completely resolve the condition, then the bilateral code would still be appropriate.