Practices don’t have as many rules to go by for billing bilateral procedures as do ASC facilities. You need to inquire about payer requirements and specific rules about modifier usage. If a surgical procedure is by definition unilateral and is performed bilaterally, the provider should report the CPT code on the claim form in a bilateral manner. Modifier 50 identifies a procedure performed identically on the opposite side of the body (mirror image). Some payers prefer the use of the RT anatomic modifier on one code and the LT modifier on the other. Do not mix the use of 50 and RT or LT modifiers on the same code. Be consistent in the method used for claims going to a particular payer.
Orthopedic billing is complicated and covers a wide scope of services and procedures when compared to most medical specialties. Payer-specific rules and guidelines, combined with complex billing codes, often leave many practices underqualified and underpaid.
Our billing team collaborates with your practice to help identify problem areas such as the correct use of modifiers, and educate your practice on best practices and procedures. Our team of certified medical billing experts and medical coders will manage all aspects of your billing to help maximize the reimbursement for services rendered.