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Is Modifier 50 Appropriate? Here’s an Easy Way to Check

Posted on 13. Jul, 2009 by in Hot Coding Topics

Not sure whether it’s appropriate to use modifier 50? Let the Medicare Physician Fee Schedule be your trusty guide. Here’s how it works.

By checking the fee schedule’s BILAT SURG column, you can determine whether Medicare will reimburse for a given code with modifier 50 (Bilateral surgery), when appropriate.

Quick explanation: You should apply modifier 50 only when the BILAT SURG column contains a “1″ for the chosen code.

A “0” indicator means that you should not apply modifier 50 (or modifiers LT, Left side; and RT, Right side). In these cases, a bilateral adjustment is inappropriate because of physiology or anatomy, or because the code description specifically states that it is a unilateral procedure and there is an existing code for the bilateral procedure, according to CMS guidelines.

Example: Code 51102 (Aspiration of bladder; with insertion of suprapubic catheter) contains a 0 in the BILAT SURG column. Because the...

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