ReginaB_62933
New member
I need to know how to code 65400 both eyes with Medicare mine has got denied 4x. Also 66821 both eyes.
Thank you
regina
Thank you
regina
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Resolved Both Eyes HELP
- Thread starter ReginaB_62933
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Hi Regina, did you add modifiers to these, Medicare in my experience likes RT, LT modifiers if the CPT does not state unilateral or bilateral in the description.
Lori
Well-known member
Yes, you may need a modifier.
68821 for example if it is done bilaterally use modifier 50 & if done unilateral apply modifier RT or LT.
Please see this thread on denials.
www.cco.community
68821 for example if it is done bilaterally use modifier 50 & if done unilateral apply modifier RT or LT.
Please see this thread on denials.
Resource - Denials
Review Reason Codes and Statements CMS contractors medically review some claims (and prior authorizations) to ensure that payment is billed (or authorization requested) only for services that meet all Medicare rules. If the review results in a denied/non-affirmed decision, the review contractor...
www.cco.community
ReginaB_62933
New member
Thanks to you for answering me
I am in a ASC so I thought with ASC you do not use modifiers, but to answer question I have tried with modifier 50 with bilateral diagnosis, also i have done RT with again bilateral diagnosis on one line then diagnosis for RT eye then next line do LT same way as RT, I have added a 50 at the end of LT, doubled the amount you can not believe all i have one to get these and i say these claims to go through.
I am in a ASC so I thought with ASC you do not use modifiers, but to answer question I have tried with modifier 50 with bilateral diagnosis, also i have done RT with again bilateral diagnosis on one line then diagnosis for RT eye then next line do LT same way as RT, I have added a 50 at the end of LT, doubled the amount you can not believe all i have one to get these and i say these claims to go through.
do you know what the bilat surg indicator is on these codes, 50 would not be acceptable for an ASC.
Lori
Well-known member
Medicare Claims Submissions
There is a separate set of billing rules for ASCs. While some issues may be addressed by CMS, most billing guidelines are best obtained from your local carrier or intermediary.
Medicare Claims Submissions
There is a separate set of billing rules for ASCs. While some issues may be addressed by CMS, most billing guidelines are best obtained from your local carrier or intermediary. Some carriers/intermediaries issue very detailed guides (e.g., Trailblazer), while others may simply provide a list of links to the CMS website (e.g., Empire).
To reiterate, an ASC must not report separate line items, HCPCS Level II codes, or any other charges for procedures, services, drugs, devices, or supplies that are packaged into the payment allowance for covered surgical procedures. The allowance for the surgical procedure itself includes these other services or items.
CMS does, however, strongly encourage billing for drug and biologicals that are eligible for separate payment. ASCs should report supplies with the correct HCPCS Level II code and correct number of units on the claim form.
Modifiers in the ASC
Some modifiers used in the ASC are the same as those used by physicians, while others are unique to the ASC facility. Modifiers recognized for ASC claim filing are (these are abbreviated descriptions):
www.aapc.com
As stated in Pub. 100-04, Medicare Claims Processing Manual, Chapter 14 - Ambulatory Surgical Centers, Section 40.5 - Payment for Multiple Procedures, a procedure performed bilaterally in one operative session is reported as two procedures, either as a single unit on two separate lines or with “2” in the units field on one line. The multiple procedure reduction of 50 percent applies to all bilateral procedures subject to multiple procedure discounting. For example, if lavage by cannulation; maxillary sinus (antrum puncture by natural ostium) (CPT code 31020) is performed bilaterally in one operative session, report 31020 on two separate lines or with “2” in the units field. Depending on whether the claim includes other services to which the multiple procedure discounts applies, the contractor applies the multiple procedure reduction of 50 percent to the payment for at least one of the CPT code 31020 payment rates.
Therefore, bilateral procedures furnished in ASCs should be reported as either a single unit on two separate lines (appending the RT and LT modifiers) or with "2" in the units field on one line, in order for the bilateral procedures to be paid correctly. The multiple procedure reduction of 50 percent will apply to all bilateral procedures subject to multiple procedure discounting. Effective for services rendered on or after March 26, 2018, claims by ASCs inappropriately billed with a modifier 50 will be rejected.
https://www.cms.gov/medicare-covera...95&Cntrctr=300&ContrVer=1&CntrctrSelected=300
-50 Bilateral Procedures
For Bilateral procedures, use the -50 or -RT/-LT modifiers when an identical procedure is
performed on both the Right and Left sides of the body. The policies payors have for the use of
modifiers for reporting bilateral procedures can vary. Check with each payor for their preferred
method of billing bilateral procedures. Do not mix methods or modifier types. Never use the
-RT/-LT Modifiers on the same code listed on the claim as one line item. Billing with one line
item can only be done using the -50 Modifier (which is not accepted by Medicare). Do not mix
the -50 Modifier with –RT or –LT Modifiers. Do not use Bilateral Modifiers on those CPT codes
with verbiage describing procedures as “Bilateral” or “Unilateral or Bilateral”.
Since Medicare no longer allows use of the -50 Modifier for billing Bilateral procedures, the
following methods for billing Bilateral procedures are allowed: Do NOT use the -50 Modifier on
Medicare claims.
List the same code as two line items with no Modifiers:
64475
64475
Bill the code as one line item, with no Modifier and list a “2” in the Units field
on the claim form – be sure to double the fee, if this method is used:
64475 2 Units
If you experience denials using either of the above methods on your Medicare claims, try using
the –RT and –LT Modifier method.
Bill the same code twice with the –RT and –LT Modifiers:
64475-RT
64475-LT
There is a separate set of billing rules for ASCs. While some issues may be addressed by CMS, most billing guidelines are best obtained from your local carrier or intermediary.
Medicare Claims Submissions
There is a separate set of billing rules for ASCs. While some issues may be addressed by CMS, most billing guidelines are best obtained from your local carrier or intermediary. Some carriers/intermediaries issue very detailed guides (e.g., Trailblazer), while others may simply provide a list of links to the CMS website (e.g., Empire).
To reiterate, an ASC must not report separate line items, HCPCS Level II codes, or any other charges for procedures, services, drugs, devices, or supplies that are packaged into the payment allowance for covered surgical procedures. The allowance for the surgical procedure itself includes these other services or items.
CMS does, however, strongly encourage billing for drug and biologicals that are eligible for separate payment. ASCs should report supplies with the correct HCPCS Level II code and correct number of units on the claim form.
Modifiers in the ASC
Some modifiers used in the ASC are the same as those used by physicians, while others are unique to the ASC facility. Modifiers recognized for ASC claim filing are (these are abbreviated descriptions):
- 52 Reduced services
- 59 Distinct separate procedure
- 73 Procedure discontinued after prep for surgery
- 74 Procedure discontinued after anesthesia administered
- RT Right side
- LT Left side
- TC Technical component
- FB Device furnished at no cost/full credit
- FC Device furnished at partial credit
- PT Screening service converted to a diagnostic or therapeutic service
- PA Wrong body part
- PB Surgery wrong patient
- PC Wrong surgery on patient
- GW Surgery not related to hospice patient’s terminal condition
ASC Coding and Billing: Know What’s Important
This overview will help you know what’s most important when coding and billing in the ambulatory surgery center (ASC) setting.
Approved Surgical Procedures
For Medicare patients, you cannot perform just any procedure in the ASC setting. Medicare has an “approved” list of procedures for the ASC that CMS has determined not to pose a significant safety risk, and that is not expected to require an overnight stay following the surgical procedure. Medicare publishes this list of covered procedures annually. Updates are published quarterly, or as necessary.The list of approved procedures is based on the criteria:
- They are NOT emergent or life-threatening (for example, a heart transplant or reattachment of a severed limb).
- They cannot be performed safely in a physician’s office.
- They can be elective.
- They can be urgent.
- Procedures also do not involve major blood vessels or result in major blood loss, and cannot involve prolonged invasion of a body cavity.
As stated in Pub. 100-04, Medicare Claims Processing Manual, Chapter 14 - Ambulatory Surgical Centers, Section 40.5 - Payment for Multiple Procedures, a procedure performed bilaterally in one operative session is reported as two procedures, either as a single unit on two separate lines or with “2” in the units field on one line. The multiple procedure reduction of 50 percent applies to all bilateral procedures subject to multiple procedure discounting. For example, if lavage by cannulation; maxillary sinus (antrum puncture by natural ostium) (CPT code 31020) is performed bilaterally in one operative session, report 31020 on two separate lines or with “2” in the units field. Depending on whether the claim includes other services to which the multiple procedure discounts applies, the contractor applies the multiple procedure reduction of 50 percent to the payment for at least one of the CPT code 31020 payment rates.
Therefore, bilateral procedures furnished in ASCs should be reported as either a single unit on two separate lines (appending the RT and LT modifiers) or with "2" in the units field on one line, in order for the bilateral procedures to be paid correctly. The multiple procedure reduction of 50 percent will apply to all bilateral procedures subject to multiple procedure discounting. Effective for services rendered on or after March 26, 2018, claims by ASCs inappropriately billed with a modifier 50 will be rejected.
https://www.cms.gov/medicare-covera...95&Cntrctr=300&ContrVer=1&CntrctrSelected=300
-50 Bilateral Procedures
For Bilateral procedures, use the -50 or -RT/-LT modifiers when an identical procedure is
performed on both the Right and Left sides of the body. The policies payors have for the use of
modifiers for reporting bilateral procedures can vary. Check with each payor for their preferred
method of billing bilateral procedures. Do not mix methods or modifier types. Never use the
-RT/-LT Modifiers on the same code listed on the claim as one line item. Billing with one line
item can only be done using the -50 Modifier (which is not accepted by Medicare). Do not mix
the -50 Modifier with –RT or –LT Modifiers. Do not use Bilateral Modifiers on those CPT codes
with verbiage describing procedures as “Bilateral” or “Unilateral or Bilateral”.
Since Medicare no longer allows use of the -50 Modifier for billing Bilateral procedures, the
following methods for billing Bilateral procedures are allowed: Do NOT use the -50 Modifier on
Medicare claims.
List the same code as two line items with no Modifiers:
64475
64475
Bill the code as one line item, with no Modifier and list a “2” in the Units field
on the claim form – be sure to double the fee, if this method is used:
64475 2 Units
If you experience denials using either of the above methods on your Medicare claims, try using
the –RT and –LT Modifier method.
Bill the same code twice with the –RT and –LT Modifiers:
64475-RT
64475-LT
- Status