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Part B Insider (Multispecialty) Coding Alert

Bilateral Procedures:
One Size Doesn't Fit All for Bilateral Services

Regs don't just differ between MACs--they also vary within the same MAC. When you perform a procedure bilaterally, do you append one modifier to a single code, bill it twice on separate line items, or use anatomic site modifiers to identify where the procedure was performed? Interestingly, all of these methods may be correct for different insurers--and that's why bilateral billing can cause headaches for even the most seasoned coders and billers. Background: Some procedures are inherently unilateral, so if you perform them bilaterally, you can collect extra reimbursement for them, typically by appending modifier 50 (Bilateral procedure), or by indicating the site you addressed with modifiers LT (Left side) and RT (Right side). For Medicare claims, bilateral billing is only appropriate when the bilateral surgery indicator for a particular code is "1" or "3" according to the Medicare Physician Fee Schedule. Problem Exists Within Medicare and Beyond Various Part [...]

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Part B Insider (Multispecialty) Coding Alert

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