How do I know if a CPT code needs a laterality modifier?

How do I know if a CPT code is bilateral?

If the code has an indicator of two, it is a bilateral procedure code. You would not need to add a modifier 50 because the code is already bilateral. A code with this indicator lets the insurance company know that both sides were done. Claims will be processed at 100% of the allowable.

Does CPT code 20526 need a modifier?

Does CPT 20526 Need a Modifier? - Use this modifier if the therapeutic injection is performed on both wrists during the same session. - Apply this modifier if multiple procedures are performed during the same session, including the therapeutic injection for carpal tunnel.

When to use LT modifier?

In some instances, procedure codes do not indicate on which side of the body a procedure is performed. In those instances, the modifier LT (left) or RT (right) is used to indicate the side of the body on which a service or procedure is performed.

Does CPT code 20610 need a modifier?

The appropriate site modifier (RT or LT) must be appended to CPT code 20610 or CPT code 20611 to indicate if the service was performed unilaterally and modifier (-50) must be appended to indicate if the service was performed bilaterally.

When signing a CPT code which of the following is the purpose of a modifier?

A modifier indicates that a service or procedure performed has been altered by some specific circumstance but not changed in its definition or code.

Does CPT require a modifier?

According to CPT, the situations when the use of a modifier may be appropriate are: 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.

How do you code laterality?

“Some ICD-10-CM codes indicate laterality, specifying whether the condition occurs on the left, right or is bilateral. If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side.

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.

How do you know which modifier to use?

The correct modifier to use is determined by payor preference. There can be instances where a CPT code is further defined by an HCPCS modifier, for example, to describe the side of the body the procedure is performed on, such as left (modifier -LT) or right (modifier -RT).

How to use modifiers with CPT codes?

CPT modifiers are added to the end of a CPT code with a hyphen. In the case of more than one modifier, you code the “functional” modifier first, and the “informational” modifier second.

Do I need a modifier for 99214?

Does 99214 need a modifier? Modifiers can be used with 99214 if applicable. For example, you can add Modifier 25 to the E/M visit with 99214 if there was a “separately identifiable E/M on the same day of a procedure” (source: ACC). Or add modifier 22 if the procedure was extra complex.

How do you know if a CPT code needs a modifier?

How to bill 99213 and 20610 together?

Use the E/M code with a modifier (for example, 99213-25), as well as the knee joint aspiration procedure code 20610. Thus, when a new problem requires more than a cursory review, the visit generally qualifies for an E/M with modifier -25.

Is 20610 bilateral?

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 is the modifier for CPT code 20610?

If the provider performs injections on separate, non-symmetrical joints (e.g., left shoulder and right knee), you may report two units of 20610 and append modifier 59 Distinct procedural service to the second unit (e.g., 20610, 20610-59) to indicate the second procedure occurred at a different joint.

When should a modifier be used?

“Its use allows two E/M services or a procedure plus an E/M service that are distinctly different but required for the patient's condition to be appropriately reported and, therefore, appropriately paid,” the issue brief says. The use of modifiers provides supplementary information for payer policy requirements.

What is the TA modifier used for?

Definition: Append modifier TA to identify that the provider performs a procedure on the great toe of the left foot.

Does CPT 69200 require a modifier?

Code 69200 (removal of foreign body, external auditory canal) would be reported with modifier 50 (bilateral procedure) to signify to the payer that a bilateral procedure was performed.

Does the CPT code 20550 need a modifier?

Does CPT 20550 Need a Modifier? - Use this modifier if the injection is performed on both sides of the body during the same session. - Apply this modifier when multiple procedures, other than E/M services, are performed by the same provider during the same session.

Does CPT code 25605 need a modifier?

Does CPT 25605 Need a Modifier? - Use this modifier if the work required to treat the fracture was substantially greater than typically required. Documentation must support the additional effort.