Forum - Questions & Answers

Aug 9th, 2011 - michelle.advancedortho 2 

Ultra Sound guided injections

Can you get reimbursed for using 76942 RT and 76942 LT on the same patient in the same visit? We are doing Synvisc One injections and just started using an ultra sound machine for guided injections. So the question is will we be reimbursed for a bilateral procedure?

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Aug 10th, 2011 - jschmutz   323 

re: Ultra Sound guided injections

76942 has a bilateral modifier indicator of "2" which means that 150% payment adjustment for bilateral procedures does NOT apply. You can bill this with a RT and LT modifier for specificity but it will not be paid at the bilateral fee.

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Aug 10th, 2011 - michelle.advancedortho 2 

re: Ultra Sound guided injections

I am still confused. Does that mean that they will pay at 100% for the first and 50% of the second?

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Aug 11th, 2011 - jschmutz   323 

re: Ultra Sound guided injections

2 = 150% payment adjustment does not apply. RVUs are already based on the procedure being performed as a bilateral procedure. If the procedure is reported with modifier -50 or is reported twice on the same day by any other means (e.g., with RT and LT modifiers or with a 2 in the units field), base the payment for both sides on the lower of (a) the total actual charge by the physician for both sides, or (b) 100% of the fee schedule for a single code. Example: The fee schedule amount for code YYYYY is $125. The physician reports code YYYYY-LT with an actual charge of $100 and YYYYY-RT with an actual charge of $100. Payment should be based on the fee schedule amount ($125) since it is lower than the total actual charges for the left and right sides ($200).
The RVUs are based on a bilateral procedure because (a) the code descriptor specifically states that the procedure is bilateral, (b) the code descriptor states that the procedure may be performed either unilaterally or bilaterally, or (c) the procedure is usually performed as a bilateral procedure.

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Aug 11th, 2011 - michelle.advancedortho 2 

re: Ultra Sound guided injections

thank you!!! I appreciate your help!

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