Avoid the Top 10 Modifier Mistakes – Modifier 50

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Avoid the Top 10 Modifier Mistakes Modifier 50
Matching CPT code with an ICD 10 code, this would
seem to be a very straightforward process but
there are always variations/exceptions to
everything. Sometimes, there are related services
that the physician is performing, global periods
to contend with, etc. Modifiers will clarify
extenuating circumstances, which should allow for
payment when they otherwise may not. That said,
the improper use of modifiers can be the cause of
claim denials just as not using a modifier can
be. When using modifiers, make sure you clearly
understand what the modifier entails. In this,
and the following blogs, we identify 10 of the
most commonly misused modifiers to help you
become more aware of the issues surrounding them.
Well help you understand why they are
problematic and how you can use them
correctly. Modifier 50 Modifier 50 is used to
report bilateral procedures that are performed
during the same operative session by the same
physician in either separate operative areas
(e.g. hands, feet, legs, arms, ears), or one
(same) operative area (e.g. nose, eyes,
breasts). Different carriers require different
reporting of bilateral procedures and offer
different reimbursement methodologies. For
examples of common carrier preferences, see
Table.
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Avoid the Top 10 Modifier Mistakes Modifier 50
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Sample Carrier Preferred Format Example of Units
Modifier 50 on one line Line 1 XXXXX-50 1 Unit
Procedure on two linesModifier 50 appended to the second procedure Line 1 XXXXXLine 2 XXXXX-50 1 Unit1 Unit
LT/RT modifiersAppended to the procedure on one lineBilled as 2 units Line 1 XXXXX-LT, RT 2 Units
Procedure listed twiceRT/LT modifiers appendedModifier 59 on the second procedure Line 1 XXXXX-LTLine 2 XXXXX-59, RT 1 Unit1 Unit
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Avoid the Top 10 Modifier Mistakes Modifier 50
When using Modifier 50 to indicate a procedure
was performed bilaterally, the modifiers LT
(Left) and RT (Right) should not be billed on the
same service line.  Modifiers LT or RT should be
used to identify which one of the paired organs
were operated on.  Billing procedures as two
lines of service using the left (LT) and right
(RT) modifiers are not the same as identifying
the procedure with Modifier 50. Example of
inappropriate will be The terminology for
procedure code 27158 (osteotomy, pelvis,
bilateral) indicates the procedure is performed
bilaterally. Therefore its not appropriate to
report modifier 50 with this procedure
code. This modifier can be the cause of several
errors. First, some CPT codes have laterality
built into the code descriptor, rendering the use
of modifier 50 (Bilateral procedure) redundant.
Second, some payers, including Medicare, prefer
you to use Level II (HCPCS) modifiers RT (Right
side) and LT (Left side) to specify the side of
the body on which your provider performed the
service. How you should use it Make sure you
know your payers preference before using 50, RT,
or LT. You can also check to see which CPT codes
will take 50 by
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Avoid the Top 10 Modifier Mistakes Modifier 50

• going to the Physician Fee Schedule Search page
• entering a valid CPT code number
• checking All modifiers in the appropriate
  drop-down
• hitting Search
• clicking the Show All Columns link
• Then scrolling over to the BILT SURG column.
• You should never attach 50 to codes with
  indicators 0, 2, and 9 in that column however,
  you can use the modifier on codes with indicators
  1 or 3.
• Example1 Procedure code 19303 (Mastectomy,
  simple, complete) is performed bilaterally,
  report the service as 19303 and append modifier
  50.
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• Example2 A physician performs removal of
  impacted cerumen with instrumentation on both
  ears. You report 69210 (Removal impacted cerumen
  requiring instrumentation, unilateral) for the
  procedure, and append modifier 50 to 69210 to
  show the procedure was bilateral as the 69210
  descriptor contains the word unilateral, and is
  thus a modifier 50 opportunity.