How do I know if a CPT code is bilateral?
Asked by: Rudy Cronin | Last update: February 13, 2025Score: 4.4/5 (38 votes)
What is a bilateral CPT code?
Use modifier 50 to report bilateral procedures performed during the same operative session by the same physician in either separate operative areas (e.g., hands, feet, legs, arms, ears) or in the same operative area (e.g., nose, eyes, breasts).
How do I know if a CPT code needs a laterality modifier?
The -RT and -LT modifiers should be used whenever a procedure is performed on one side. For instance, when reporting CPT code 27560 (closed treatment of patellar dislocation; without anesthesia), modifier -RT or -LT should be appended if only one knee is treated.
Where can I find the bilateral surgery indicator?
The CMS Medicare Physician Fee Schedule Data Base (MPFSDB) and the Novitas Fee Schedule search tool provide bilateral indicators identifying procedures eligible for bilateral billing (see screen shots below). Only CPT codes with an indicator of “1” or “3” are eligible for bilateral billing.
What is the code for bilateral?
The modifier 50 is defined as a bilateral procedure performed on both sides of the body. Services will be rejected as unprocessable when the procedure code reported is inconsistent with the modifier used.
When Do You Use a CPT Code or HCPCS Level II Code?
How are bilateral codes assigned?
Some ICD-10-CM codes specify whether the condition occurs on the left or right, or is bilateral. If no bilateral code is provided and the condition is bilateral, then codes for both left and right should be assigned. If the side is not identified in the medical record, then the unspecified code should be assigned.
Is 31238 a bilateral code?
31238 can be billed bilaterally, but if your doctor only performed the endoscopic electrocautery on the left side, I would say that you shouldn't apply the 50 modifier. It wouldn't be considered a bilateral surgery since he/she did not perform it on the right side as well.
What is a CPT status indicator?
Status indicator or “SI” means a payment indicator that identifies whether a service represented by a CPT or HCPCS code is payable under the OPPS APC or another payment system. Only one status indicator is assigned to each CPT or HCPCS code.
What is modifier 26 in CPT coding?
• Modifier 26 is appended when a physician provides the professional component only of the global fee. and when the physician prepares a written interpretation and report. • Modifier 26 should only be appended to codes which are listed in the CMS NPFSRVF as modifier 26. appropriate.
How do you know if a CPT code needs a modifier?
- The service or procedure has both professional and technical components.
- More than one provider performed the service or procedure.
- More than one location was involved.
- A service or procedure was increased or reduced in comparison to what the code typically requires.
Is CPT code 20610 a bilateral procedure?
Generally, one unit of the 20610 CPT code should be reported for each joint treated. However, multiple units may be reported for multiple joints or bilateral procedures using appropriate modifiers.
What modifier a coder would use for indicating a bilateral procedure was done?
* AMA Current Procedural terminology (CPt) indicates that “unless otherwise identified in the listing, bilateral procedures that are performed at the same session should be identified by adding modifier 50 to the appropriate five digit code.”† the Healthcare Common Procedure Coding System (HCPCS) uses modifiers Lt ( ...
Is CPT 58661 a bilateral code?
Coding Brief: Reporting Code 58661 for Bilateral Procedure (May 2024) - AMA CPT® Assistant.
Is CPT 70336 bilateral?
The standard is to perform the study as a bilateral procedure. Radiology, Diagnostic, 70336 (Q&A). CPT® Assistant.
Is CPT 69436 a bilateral code?
Modifier 50
In this example, CPT® code 40701 (plastic repair of cleft lip/nasal deformity; primary bilateral, one stage procedure) is the primary procedure and CPT code 69436 (tympanostomy [requiring insertion of ventilating tube], general anesthesia) is the secondary procedure. Both procedures are bilateral.
Is 69200 a bilateral code?
Code 69200 only takes into account foreign body removal without anesthesia unilaterally. Therefore, if the physician has to perform this service bilaterally, you can report the 69200 code on one line item and 69200 with the 50 modifier (bilateral procedure) on the next line item.
What is the bilateral procedure rule?
Bilateral surgeries are procedures performed on both sides of the body during the same operative session or on the same day.
Is 92072 a bilateral code?
92072 (Fitting of Contact Lens for Management of Keratoconus, Initial Fitting). Note - this is a BILATERAL code, meaning that you use this code to bill for both eyes. If you are only fitting one eye, make sure to use a modifier.
How do you determine which CPT code is primary?
Often, a parenthetical note will identify the primary code(s) with which the add-on code must be reported. For example, following 10004 in the CPT® codebook is a parenthetical instruction “Use 10004 in conjunction with 10021.” On other occasions, however, the codebook doesn't provide the primary procedure code(s).
What 3 things does the CPT code tell you?
Category I: Procedures, services, devices, and drugs (including vaccines) Category II: Performance measures and quality of care (for example, patient follow-up) Category III: Services and procedures using emerging technology (these codes are usually temporary while the service or procedure is still fairly new)
Is 31237 a bilateral code?
31237 – nasal/sinus endoscopy, surgical with biopsy, polypectomy, or debridement (separate procedure). Use modifier 52 to indicate the decreased level of service provided as a Post Op FESS procedure (31237-52 LT, or 31237-52 RT or to indicate bilateral procedure 31237-52-50).
Is 69210 a bilateral code?
Additionally, the descriptor of 69210 has been clarified to reflect that the code is inherently unilateral. For bilateral impacted cerumen removal, report code 69210 with modifier 50, Bilateral Procedure, appended.
Can 64635 be billed bilaterally?
CPT code 64634 should be used in conjunction with 64633 and 64636 should be used in conjunction with 64635. Laterality: For bilateral procedures report modifier -50 on each line in which the intervention was of a bilateral nature. For services performed in the ASC, physicians must continue use modifier -50.