Health Information Management

Tip of the Week: Don't replace modifier -50 with -LT/-RT

APCs Insider, April 27, 2007

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Dave Fee, MBA, marketing manager of outpatient products for 3M Health Information Systems in Salt Lake City says at least one FI has allowed hospitals to report a bilateral procedure CPT code with both modifier -LT (left side) and  -RT (right side) together on a single line item, instead of modifier -50 (bilateral procedure). "It's an incorrect practice to use an -LT and an -RT modifier instead of -50," Fee says.

He also notes the negative financial implications: The outpatient code editor (OCE) edits for line items with modifier -50, and will pay that line item at 150% of the reimbursement for the procedure. However, a procedure code appended with both -LT and -RT will pay only 100% of the APC reimbursement.

For example, if a physician performed a knee arthroscopy (e.g., 29871, arthroscopy, knee surgical; for infection, lavage, and drainage) on both of the patient's knees, and the hospital reports 29871-LT-RT, they will receive only $1,759.49 (unadjusted payment for APC 0041). But if they correctly reported 29871-50, the hospital would receive $2639.24 (assuming the FI paid 150% of 29871).

And don't assume the outpatient code editor (OCE) will correct the problem for you: "The OCE only looks for modifier -50, it won't tell you that [reporting -LT and -RT] is wrong," says Fee.

(Source: Briefings on APCs, May 2007).



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