Health Information Management

Tip: Correctly code bilateral pain management procedures

APCs Insider, July 16, 2010

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Bilateral procedures can be a challenge to coders, especially when modifiers accompany procedure codes. Most pain management CPT codes represent unilateral procedures (e.g., CPT code 64479 [transforaminal ESI]), but not all do (e.g., 22526 [percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level]). Check the code description to sdetermine whether a code is inherently bilateral.

Consider these methods for billing bilateral procedures:

  • Bill a single line item with no modifier and two or more units in the units column on the claim form. If you do that, remember to double the fee.
  • Bill the same code as two separate line items with anatomic modifier -RT on one code and anatomic modifier -LT on the other code.
  • Bill a bilateral procedure as two line items with no modifier on the first code and modifier -50 (bilateral procedure) on the second code.
  • Bill a single line item listing the code once with modifier -50. Be sure to double the fee if you use this method.
  • Bill the same code as two line items with no modifiers. Use of this billing method is not advisable because you likely will receive a denial for a duplicate.

This tip is adapted from Cure what ails your pain management coding in the July issue of Briefings on APCs.



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