Reporting Unilateral or Bilateral Codes
December 18th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Generally, Audiology tests are coded as if they were performed on both ears, if the testing was performed only on one ear, you are required to append a modifier to acknowledge there was a reduced service or a unilateral assessment, using modifier 52 - Reduced Services.
(Be sure to read the code descriptor to verify you are coding for a unilateral or bilateral procedure). Always refer to the Payment rules to determine Bilateral Payment rules when using Modifier 50 as well: For example, if a procedure has a payment indicator of "0", do not use Modifier 50 - Bilateral surgery payment rules do not apply. If a code has a payment indicator of "1" then Bilateral surgery payment rules do apply and reimbursement is at 150%.
The use of HCPCS Level II Modifiers - RT and LT, should only be used when Bilateral Surgery rules DO NOT apply according to CMS.
Codes with an indicator of "0" can never be billed with modifier 50.
Codes with an indicator of "3" can be billed with 50 or LT/RT. These services are generally radiologic and other diagnostic services. (When these services are performed bilaterally most payers want them billed with LT/RT)
Codes that have an indicator of "3" that are billed bilaterally receive reimbursement for each code billed.
Codes that have an indicator of "0" that are billed using LT/RT receive reimbursement for a single code.
###
Questions, comments?
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)
What’s Going on with the COVID Vaccines Now?May 4th, 2023 - Wyn StaheliKeeping up with the changes to the COVID vaccines has certainly been a rollercoaster ride and we now have two new twists to this exciting ride. Buckle up and let’s look at how this changes things.
Reporting Modifiers 76 and 77 with ConfidenceApril 18th, 2023 - Aimee WilcoxModifiers are used to indicate that a procedure has been altered by a specific circumstance, so you can imagine how often modifiers are reported when billing medical services. There are modifiers that should only be applied to Evaluation and Management (E/M) service codes and modifiers used only with procedure codes. Modifiers 76 and 77 are used to identify times when either the same provider or a different provider repeated the same service on the same day and misapplication of these modifiers can result in claim denials.
Five Documentation Habits Providers Can Use Implement to Improve Evaluation & Management (E/M) ScoringApril 11th, 2023 - Aimee WilcoxProvider education on E/M coding updates is vital to the success of any organization, but how do you whittle down the massive information into bite-sized pieces the providers can learn in just a few minutes? Check out the five steps we have identified to teach providers in just a few minutes that can significantly impact and improve coding outcomes.
Second Quarter 2023 Updates are Different This YearApril 6th, 2023 - Wyn StaheliThe second quarter of 2023 is NOT business as usual so it is important to pay attention to ensure that organizational processes and training take place to avoid mistakes. Not only have ICD-10-CM coding updates been added to the usual code set updates (e.g., CPT, HCPCS, ICD-10-PCS), but the end of the COVID-19 Public Health Emergency will bring about changes that will also take place during the quarter (but not on April 1, 2023.
7 Measures Developed by the HHS Office of Inspector General (OIG) to Identify Potential Telehealth FraudMarch 28th, 2023 - Aimee WilcoxA recent review of telehealth services reported in Medicare claims data during the pandemic where these seven measures for identifying suspected fraud, waste, and abuse were applied, revealed more than a thousand Medicare providers potentially committed fraud during this period. What are the measures the OIG applied during their review, and how will that impact future telehealth guidelines moving forward?
MUEs and Bilateral IndicatorsMarch 23rd, 2023 - Chris WoolstenhulmeMUEs are used by Medicare to help reduce improper payments for Part B claims. This article will address the use of the National Correct Coding Initiative (NCCI) and Medically Unlikely Edits (MUEs) and how they are used by CMS.
It is True the COVID-19 PHE is ExpiringMarch 16th, 2023 - Raquel ShumwayThe COVID-19 PHE is Expiring, according to HHS. What is changing and what is staying the same? Make sure you understand how it will affect your practice and your patients.
