Reporting Unilateral Procedures

March 13th, 2017 - Chris Woolstenhulme, CPC, CMRS
Categories:   Coding   Billing   Dental   Oral and Maxillofacial Surgery  
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Some procedures are unilateral such as D7840-Condylectomy. It is important to consult with your payer on reporting requirements. Some payers require two separate line items with a LT or RT HCPCS Modifier, while others require only one modifier to be appended to the claim.

When billing a medical code for a Condylectomy, you would report with CPT code 21050. While this is still a unilateral procedure when reporting CPT codes, reporting with modifiers for a bilateral procedure requires using a 50 - Bilateral Procedure modifier. Some payers may require two line items with the modifier 50 appended to the second code, while other payers require a modifier 50 appended to the second line item. If performed with another procedure, use modifier 59 - Distinct Procedural Service. Modifier 59 indicates that a procedure was performed on the same day but was distinct or independent from another procedure performed on the same day.

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