Pessie Posted Thu 05th of July, 2018 16:24:39 PM
Right hand was examined and we added rt. Claim was denied for wrong modifier. Can you explain, please. Thanks
SuperCoder Answered Fri 06th of July, 2018 07:08:41 AM
In CPT code 73130, images may be taken from the posteroanterior, or back to front, lateral and or oblique views. This image shows the bones of hand, which includes the metacarpals and phalanges. According to the CMS guidelines, if the procedure is reported with modifier 50 or is reported for both sides 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 each side or organ or site of a paired organ on the lower of:
(a) the actual charge for each side or
(b) 100% of the fee schedule amount for each side.
Hence, modifier LT and RT are valid and applicable to the code 73130 and should be paid.
Also, check your payer specific guidelines regarding the RT modifier, there seems to be no problem with general coding guidelines. On the other hand, your documentation should support the medical necessity. Check your explanation of benefit (EOB) and explanation of reason of denial and appeal the claim.