How do you report bilateral procedures? One line or two?
October 14th, 2009 - Mary LeGrand
Bilateral Total Knees—How to Submit the Claim From
How do I report bilateral procedures, one line or two?
Great question, unfortunately the payors have made this simple concept of bilateral procedures challenging from a reimbursement standpoint! Survey your payors and obtain their individual instruction in writing. Even Medicare varies from Contractor to Contractor For Medicare, check your Carrier Manual or website for their instructions.
The questions to ask are:
1) Does the payor want bilateral procedures reported on one line (linear format)?
2) Does the payor want bilateral procedures reported on two lines (line item reporting)?
3) Does the payor want you to use right and left modifiers instead of the modifier 50?
If the payor prefers the linear format, then the following questions need answers:
A) Do you report one unit or two?
B) Do you submit your fee one time or double?
Example of linear reporting format:
CPT® code/modifier Charge Units
27447-50, place a 1 or 1 in the units box based on payor instructions and submit the fees at one or two times your normal fee. KZA recommends doubling the fee when reporting on one line.
If the payor prefers line item reporting, append modifier 50 to the second CPT® procedure code that is the bilateral procedure .
Example of line item reporting format:
CPT® code/modifier Charge Units
27447 Submit a 1 in the units box and submit your full fee
27447-50 Submit a 1 in the units box and submit your full fee
In either scenario, watch your reimbursement closely to ensure the payor reimburses 100% for the first procedure and 50% for the second or according to the payors multiple procedure payment formula.
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Latest articles: (any category)Artificial Intelligence in Healthcare - A Medical Coder's PerspectiveDecember 26th, 2023 - Aimee Wilcox
We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities? Specialization: Your Advantage as a Medical Coding ContractorDecember 22nd, 2023 - Find-A-Code
Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.Changes to COVID-19 Vaccines Strike AgainDecember 12th, 2023 - Aimee Wilcox
According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.Updated ICD-10-CM Codes for AppendicitisNovember 14th, 2023 - Aimee Wilcox
With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.COVID Vaccine Coding Changes as of November 1, 2023October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.Medicare Guidance Changes for E/M ServicesOctober 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....Can We Score Interpretation of an EKG Towards E/M Medical Decision Making?October 10th, 2023 - Aimee Wilcox
When EKGs are performed in the facility setting or even in the physician's office, what are the requirements for reporting the service and who gets credit for scoring data points for Evaluation and Management (E/M) medical decision making (MDM)? Let's take a look at a few coding scenarios related to EKG services to get a better understanding of why this can be problematic.