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.
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.
If you've ever taken piano lessons, you know that the thumb is considered the first finger of the hand. Anatomically, it is also referred to as the first phalanx (finger). However, when you are coding an x-ray of the thumb, images are captured of the thumb, hand, wrist, and all ...
Although it has been quite some time since ChiroCode published an article about the revised instructions for non-participating providers who use the ABN, there are still some outstanding questions about this change. So far, Medicare has not provided additional guidance about this question despite requests by us for clarification.
Medicare now requires non-participating providers to include the ...
Should you volunteer to repay money from Medicare or other federal healthcare programs if you believe they were the result of errors on your end? The penalties for not doing so could be severe. Under the Federal False Claims Act, if retained overpayments can be shown to be to false ...
As many of you are aware, CMS began issuing new Medicare identification cards last year which required the replacement of social security numbers with a new Medicare Beneficiary Identifier (MBI). All cards have now been mailed out and patient's should have the new cards when they come in. Currently, we are in the transition period until January 2020.
Providers need to ensure that they are reporting radiology dates of service the way the payer has requested. Unlike other many other professional services which only have one date of service (DOS), radiology services can span multiple dates. Medicare requirements may differ from professional organization recommendations.
A global period is a period of time starting with a surgical procedure and ending some period of time after the procedure. Many surgeries have a follow-up period during which charges for normal post- operative care are bundled into the global surgery fee. Global surgery is not restricted to hospital...
Another popular search tool is our index system Click-A-Dex Tool. Click-A-Dex is formatted like the indexing in a code book, this is a quick and easy tool for an enhanced index search. Simply start typing in the desired search, once you type in your desired condition, the results will show...