Health Information Management

Tip: Stay up-to-date with conditionally bilateral code changes

APCs Insider, May 27, 2011

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Each quarter, CMS releases updates to the Integrated Outpatient Code Editor (I/OCE), with revisions sometimes affecting whether a code is inherently or conditionally bilateral.

When a provider performs a conditionally bilateral service ¬bilaterally, coders must append modifier -50 (bilateral procedure) to the code.

If a code is inherently bilateral, coders should not append modifier -50 when the service is performed bilaterally. CMS added 34 codes to the conditionally bilateral list in its April update.
CMS also made six codes inherently bilateral, so coders must remember that they should not append modifier -50 to them. They are:

  • 64611—Chemodenervation of parotid and submandibular salivary glands, bilateral
  • 92132—Scanning computerized ophthalmic diagnostic imaging, anterior segment
  • 92133—Scanning computerized ophthalmic diagnostic imaging, posterior segment; optic nerve
  • 92134—Scanning computerized ophthalmic diagnostic imaging, posterior segment; retina
  • 92227—Remote imaging for detection of retinal disease
  • 92228—Remote imaging for monitoring and ­management of active retinal disease

The tip is adapted from “I/OCE edits: Look for bilateral status changes, new modifier” in the May issue of Briefings on APCs.



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