Evelyn Posted Wed 11th of May, 2011 16:04:31 PM
what is the best code for X-Ray orbits to look for metal prior to an MRI?
SuperCoder Answered Wed 11th of May, 2011 17:21:48 PM
I believe the code 70020, which is appropriate for x-ray orbits for the evalution of trauma, tumors, or foreign bodies.
70030 (Radiologic examination, eye, for detection of foreign body) is also an another option (orbit is not mentioned here), but these are usually not paid by the carriers, but dx code V71.89 (other specified suspected conditions) could be used if no foreign body is found.
Evelyn Posted Wed 11th of May, 2011 19:29:39 PM
do you mean 70200? 70020 does not appear to be valid.
Can 70030 be billed for rt/lt even if only one film is done?
SuperCoder Answered Thu 12th of May, 2011 01:12:00 AM
1) Sorry Evelyn, it is actually 70200, not 70020, it is typo error.
2) No.. 70030 is a unilateral procedure. If performed bilaterally (both sides), according to the payer’s requirements, it can be billed. Some payers require that the service be reported twice with modifier 50 appended to the second code or LT/RT on the same detail ine, while others require identification of the service only once with modifier 50 appended. It should be checked by individual payers as per their requirements. Modifier 50 identifies a procedure performed identically on the opposite side of the body (mirror image).
Code 70030 has a Bilateral Indicator of “3” on the MPFS Database (MPFSDB). This means, when performed bilaterally, the full fee schedule amount is payable for “each” side. The 50 percent reduction that occurs with Bilateral Indicator “1” procedure codes is not applicable to Bilateral Indicator “3” procedure codes. In order to receive the full fee schedule amount for Bilateral Indicator “3” procedure codes performed bilaterally, the days/units (quantity billed) field must reflect “2” even when submitting CPT modifier 50 or when submitting HCPCS modifiers RT and LT on the same detail line.