billing modifiers

[jsaul]

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I was told by my billing company that the reason a lot of my tf esi's were being denied is that I did not use the modifers RT and LT.

apparently you have to use 64483 -RT if doing one level right sided tf esi and 64484-RT if additonal level on the right side. and LT for left sided procedures.

I have never done this or heard of this before. Is this true?

I have only used modifier -50 if doing bilateral

 

[lonelobo]

We never code for right or left, just put in our notes. Never had problems

 

[Orin]

We have been doing this over the last 12 months or so

 

[soccrwz]

depends on the insurance carrier, not all of them do that some require only the 50 modifier

 

[nvrsumr]

So to be clear if doing bilateral S1-2 tfesi would bill: 64483-RT and 64483- LT

 

[paindoc007]

So to be clear if doing bilateral S1-2 tfesi would bill: 64483-RT and 64483- LT

No.
Bilateral would be
64483-50
64484-50

Now cue the drama on performing a two level tfesi...and go.

 

[jsaul]

So to be clear if doing bilateral S1-2 tfesi would bill: 64483-RT and 64483- LT

i think it would be 64483-50 and 64484-50 in your example

if doing a right S1 tf esi it would be 64483-RT

again this modifier RT or LT is totally new to me until today

 

[jsaul]

so most everyone using these modifiers? -RT and LT? My billing company said that is the reason for nearly 50k in denials for TF Esi

 

[clubdeac]

I’ve never used them and won’t start now. Not worth an additional 3 clicks

 

[soccrwz]

Found this online for some of the main insurers

Coding Bilateral procedures; CPT Modifier 50

www.texmed.org

https://www.hcms.org/uploadedFiles/Harris_County_Medical_Society/Practice_Resources/Practice_Operations/Grids/Bilateral%20grid.pdf

 

[Tapspatellas]

I was told by my billing company that the reason a lot of my tf esi's were being denied is that I did not use the modifers RT and LT.

apparently you have to use 64483 -RT if doing one level right sided tf esi and 64484-RT if additonal level on the right side. and LT for left sided procedures.

I have never done this or heard of this before. Is this true?

I have only used modifier -50 if doing bilateral

Had the same issue at my former practice. They wanted 64483-RT and 64483-LT instead of 64483-50. Now I just write the code and -50 mod and let my coders sort it out. I have no idea if they are doing the same thing here

 

[geauxg8rs]

Had the same issue at my former practice. They wanted 64483-RT and 64483-LT instead of 64483-50. Now I just write the code and -50 mod and let my coders sort it out. I have no idea if they are doing the same thing here

I would put in 64483-50 and it would work fine for every insurer except for bcbs.

For this sole insurer a 64483-50 would pay 50% of a 64483 instead of 150%. The correct way to code for them is 64483-RT, 64483-LT-50. This way i get 100% for the right and 50% for left.
It makes no sense and every other insurer does not do this. I don’t know how you can be paid for half of a bilateral procedure!

 

[hyperalgesia]

so most everyone using these modifiers? -RT and LT? My billing company said that is the reason for nearly 50k in denials for TF Esi

Depends on the insurer, I've been denied coding both ways. There's no way to get around monitoring and resubmitting, these insurers do whatever they want and you can bet they are happy people don't notice their denials.

I just got denied a Medicare claim when Medicare was the primary payer because the word "none" was not in box 11 (it was left blank). My clearinghouse said some insurers require it to be blank. Not a damn thing to do about it, just "how do you like it?" Resubmit. Pull up pants.

 

[SSdoc33]

I’ve never used them and won’t start now. Not worth an additional 3 clicks

it is, actually

even if it doesnt matter from an RVU standpoint, your RVUs will eventually be matched to your collections, so you should collect as much as possible for your work

 

[SSdoc33]

i have found it depends of the insurer as well as the software you happen to be using. some software automatically adds the rt/lt when you click on the -50 modifier in the billing section. others dont

 

[Ducttape]

No.
Bilateral would be
64483-50
64484-50

Now cue the drama on performing a two level tfesi...and go.

Correct. That’s coding for 2 level bilateral tfesi... 4 injections.


You get paid less coding 64483 mod 50 than 64483-Rt and 64483-Lt.

Please document the procedures separately though. Otherwise they can bump it down to 150% of a 64483....

 

[clubdeac]

it is, actually

even if it doesnt matter from an RVU standpoint, your RVUs will eventually be matched to your collections, so you should collect as much as possible for your work

So if I'm only doing one side anyway, why would adding an rl/lt will increase my collections??

 

[SSdoc33]

So if I'm only doing one side anyway, why would adding an rl/lt will increase my collections??

you are right, it wont.

this only applies to bilateral procedures. some hospitals only pay you 50% of the contralateral side as far as RVUs are concerned, but insurance may reimburse more than that when you do both sides at once.

 

[olafa]

what then is the modifier you are using for RIGHT or LEFT?

 

[clubdeac]

So do you guys think if I add a right and left modifier to my procedure codes I will get paid for a bilateral? Reason I ask is because my hospital does not recognize the 50 modifier