Health Information Management

Use modifier -50 correctly when reporting bilateral radiology procedures

APCs Insider, September 12, 2008

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Question: A physician orders a bilateral radiological examination of the hand, minimum of three views, which we report using CPT code 73130.What would be the most appropriate CPT codes to use for billing this? If the radiologist performed this same procedure bilaterally, should we append modifier -50?
 
Answer: Outpatient Prospective Payment System (OPPS) modifier requirements come from the Internet-Only Manual (IOM), Medicare Claims Processing Manual, Chapter 4, Section 20, (p. 30) effective April 2008. To read Chapter 4, click here:
 
The IOM provides the following information regarding modifier -50:  
    As indicated in §20.6.2, modifier -50, while it may be used with diagnostic and radiology procedures as well as with surgical procedures, should be used to report bilateral procedures that are performed at the same operative session as a single line item. Modifiers RT and LT are not used when modifier -50 applies. A bilateral procedure is reported on one line using modifier -50. Modifier -50 applies to any bilateral procedure performed on both sides at the same session.
Verify the use of modifier -50 with your internal radiology modules and financial systems to ensure appropriate charge/code reporting with unit(s) and ensure APC revenue integrity.  
 
Editor's note: Read more about Modifier -50 in the November issue of Briefings on APCs.



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