Modifiers are two-digit symbols added to CPT procedure codes to signify that the procedure has been altered in some way. Medicare and most other payers accept modifiers; however, using modifiers correctly can be confusing, since not all payers want modifiers used the same way.
Medicare defines the ASC facility’s Global Period as 24 hours from the time the first procedure begins – it is NOT 10 or 90 days, as the physician’s Global Period might be. However, some payers other than Medicare may consider the Global Period to be 48–72 hours for ASC facilities.
Some Modifiers are for use by physician practices only, others for use on facility claims only, and others for use by both provider types. In this Blog, we have discussed the correct use of modifier 50 in ASC billing.
Not using Modifiers according to each payer’s specifications can result in unnecessary denials or incorrect payment for claims. Specific Modifiers are used when the patient returned to the OR for another procedure on the same day or within proximity to another procedure performed in your facility – which is referred to as the “Global Period” or “Postoperative Period.”
Modifier 50 in ASC Billing: Bilateral Procedures
For Bilateral procedures, use the -50 or -RT/-LT modifiers when an identical procedure is performed on both the Right and Left sides of the body. Policies payors use to report bilateral procedures can vary. Check with each payor for their preferred method of billing bilateral procedures.
Do not mix methods or modifier types. Never use the -RT/-LT Modifiers on the same code listed on the claim as one line item. Billing with one line item can only be done using the -50 Modifier (which is not accepted by Medicare). Do not mix the -50 Modifier with –RT or –LT Modifiers. Do not use Bilateral Modifiers on CPT codes that include verbiage describing procedures as “Bilateral” or “Unilateral or Bilateral”.
Correct Usage of Modifier 50 in ASC Billing and Modifiers LT and RT for Bilateral Procedures
Since Medicare no longer allows the use of the -50 Modifier for billing Bilateral procedures, the following methods for billing Bilateral procedures are allowed: Do NOT use the -50 Modifier on Medicare claims.
- List the same code as two line items with no Modifiers:
- 64475
- 64475
- Bill the code as one line item, with no Modifier and list a “2” in the Units field on the claim form – be sure to double the fee, if this method is used:
- 64475 2 Units
If you experience denials using either of the above methods on your Medicare claims, try using the –RT and –LT Modifier method
- Bill the same code twice with the –RT and –LT Modifiers:
- 64475-RT
- 64475-LT
The other methods for billing Bilateral Procedures to payors other than Medicare include the following:
- Bill the same code twice with the -50 Modifier on the 2nd code:
- 64475
- 64475-50
- Bill the code as one line item, with the -50 Modifier – be sure to double the fee if this method is used:
- 64475-50
As of January 1, 2020, you will no longer be able to report modifier 50 with add-on codes. It is essential to append the appropriate -RT and -LT Anatomic Modifiers to CPT codes on claims, when needed (e.g., Orthopedic, Podiatry, and Ophthalmology services).
When a patient has a bilateral problem (such as Bunions on both feet or Cataracts on both eyes), the surgeries to correct the problem may be done one side at a time, with the patient returning months later for the repeat procedure on the other side.
If the claim for the first surgery is submitted without the appropriate –LT or –RT Modifier, the payer will often deny the claim for the second surgery as a duplicate. It saves a great deal of time, energy, and money to append the appropriate Modifier to the code the first time through, to avoid these unnecessary denials.
Add-on codes describe services that are always performed in conjunction with a primary service by the same provider in the same encounter or patient session. The only exception to this is reporting critical care services (99291 and 99292), which may be reported by another provider within the same group practice at a different encounter session on the same date.
The Medicare Physician Fee Schedule (MPFS) identifies the global periods for add-on codes with indicator ZZZ, which means they share the same global period as the primary procedure reported with them. Reporting modifier 50 for eligible add-on codes has been a common practice until now.
Effective January 1, 2020, all add-on codes will no longer be eligible for modifier 50 due to changes in the CPT codebook. The only way to report these services now will be to use both modifier RT and modifier LT on separate lines, as seen in the following example:
Example: Diagnostic facet joint injection using dexamethasone into bilateral C3-4 and C4-5 facet joints.
Codes: 64490-50, 64491-RT, 64491-LT
Expert coders with experience at ambulatory surgery centers analyze the nuances that make coding at these institutions unique. Few in the healthcare field would argue that coding is uniquely specialized. One particular specialization that could be tagged as a subspecialty of the profession is the ambulatory surgery center (ASC), coder.
Because it’s considered a niche within the coding profession, finding coders with the foundational knowledge to survive in such a setting isn’t always easy. ASCs require coding practices that differ from those of their hospital and physician office counterparts.
In case of any assistance with the Ambulatory Surgical Center’s medical billing and coding, you can contact us at 888-357-3226/ info@medicalbillersandcoders.com
FAQs:
Modifiers are two-digit symbols added to CPT codes to indicate that a procedure has been altered in some way, providing additional information for accurate billing and claims processing.
Modifier 50 indicates that a bilateral procedure is performed on both sides of the body. However, Medicare no longer allows its use for billing bilateral procedures; instead, specific alternative methods must be followed.
For Medicare claims, bilateral procedures should be billed using one of the following methods:
1. List the same code as two line items with no modifiers.
2. Bill the code as one line item with “2” in the Units field.
3. Use -RT and -LT modifiers on separate lines for each side.
Failing to use the correct modifiers can result in claim denials, especially for procedures that require separate billing for the right and left sides, as it may be considered a duplicate claim.
If you need help with billing and coding for an ambulatory surgery center, contact Medical Billers and Coders (MBC) at 888-357-3226 or info@medicalbillersandcoders.com for expert assistance.
Catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place.
