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Re: Bilateral Injections

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  • Melinda
    Medicare B News Issue 203 April 21 2003 Injection Codes Billed Bilaterally- 20600, 20605 and 20610 Bilateral procedures are those which are performed on both
    Message 1 of 5 , Nov 9, 2010
    • 0 Attachment
      Medicare B News Issue 203 April 21 2003


      Injection Codes Billed Bilaterally- 20600, 20605 and 20610 Bilateral
      procedures are those which are performed on both sides of the body
      during the same session or on the same day. Modifier 50 is not
      applicable to procedures that are bilateral by definition or procedures
      that include the term "bilateral" in their descriptions. In the Medicare
      Physician Fee Schedule Data Base (MPFSDB), the procedure codes with the
      bilateral surgery indicator of 1 can be billed with modifier 50. (This
      is the key information right here. Check your Fee Schedule to see if
      it's billed with Mod 50 or not, by the bilateral surgery indicator of 1)

      Paper claims should be submitted with modifier 50 in Item 24d on the
      HCFA 1500 claim form (or the electronic equivalent) if services are
      being done bilaterally. If more than two modifiers are already reported
      and additional modifiers are needed, they should be submitted in the
      comment field, Item 19 or the electronic equivalent. Noridian has been
      receiving a large number of claims where modifier 50 is being billed
      incorrectly. Some examples follow:

      Example: Injection of both knees

      Incorrect Billing:

      Procedure Codes Units of Service

      20610 LT 1

      20610RT50 1

      This would be saying that you had performed arthrocentesis, aspiration
      and/or injection in three major joints or bursa.

      Incorrect Billing: 20610 50 2

      OR

      Incorrect Billing: 20610 50 1

      20610 50 1

      This would be saying that you had performed arthrocentesis, aspiration
      and/or injection in four major joints or bursa.

      Correct Billing: 20610 LT 1

      20610 RT 1

      OR

      Correct Billing: 20610 50 1

      This would indicate two major joints or bursa.

      NOTE: The diagnosis should correlate with the site of the
      aspiration/injection.

      Example: Injection of both knees and both shoulders

      Billing: 20610 50 2

      This would be correct, however, only one diagnosis can be used. If, for
      example, diagnosis 715.16 (osteoarthritis of the knee) were used, it
      would apply to the knee injections, but not the shoulder injections.
      Therefore, billing reflects injection of four knees.

      Appropriate Billing: 20610 50 1

      20610 50 1

      Each diagnosis should correlate with the site of the
      aspiration/injection. Billing on two lines allows billing the correct
      diagnosis for the knees on one line and the shoulders on the other.

      The payment amount for these bilateral procedures is 150% of the fee
      schedule. The limiting charge is 150% of the established limiting charge
      for one service.

      Note: Do not put spaces or extraneous marks such as "-" or "/" between
      the CPT code and any modifiers.

      Improper claim submission may cause a delay or denial in the processing
      of your claims.

      Applies to the states of: AK, AZ, CO, HI, IA, ND, NV, OR, SD, WA & WY.

      Posted on: 04/21/2003

      http://bbnor.noridian.com/Bulletins/Medicare_Part_B/Medicare_B_News_Bull\
      etins_and_LMRPs-LCDs_(1994_to_Current)/Medicare_B_News_Issue_203_April_2\
      2_2003/Injection_Codes_Billed_Bilaterally_20600_20605_and_20610.htm
      <http://bbnor.noridian.com/Bulletins/Medicare_Part_B/Medicare_B_News_Bul\
      letins_and_LMRPs-LCDs_(1994_to_Current)/Medicare_B_News_Issue_203_April_\
      22_2003/Injection_Codes_Billed_Bilaterally_20600_20605_and_20610.htm>


      --- In MedicalBillers@yahoogroups.com, Corri Baker
      <virtuous_gracious@...> wrote:
      >
      > Melinda,
      > I couldn't get the links to work. Would you please send them again?
      > Thanks,
      > Corri
      >
      >
      >
      >
      > ________________________________
      > From: Melinda melindadocsmith@...
      > To: MedicalBillers@yahoogroups.com
      > Sent: Tue, November 9, 2010 9:20:23 AM
      > Subject: [MedicalBillers] Re: Bilateral Injections
      >
      >
      >
      > Corri,
      >
      > This is how I've always bill Medicare and my bilateral procedures have
      > been paid correctly. I use this guideance for all my payers, unless
      > they publish a coding bulletin stating otherwise.
      >
      >
      http://bbnor.noridian.com/Bulletins/Medicare_Part_B/Medicare_B_News_Bull\
      etins_and_LMRPs-LCDs_(1994_to_Current)/Medicare_B_News_Issue_203_April_2\
      \
      >
      > 2_2003/Injection_Codes_Billed_Bilaterally_20600_20605_and_20610.htm
      >
      <http://bbnor.noridian.com/Bulletins/Medicare_Part_B/Medicare_B_News_Bul\
      letins_and_LMRPs-LCDs_(1994_to_Current)/Medicare_B_News_Issue_203_April_\
      \
      >
      > 22_2003/Injection_Codes_Billed_Bilaterally_20600_20605_and_20610.htm>
      >
      > Melinda Brown, CMBS
      > Ins Biller
      >
      > --- In MedicalBillers@yahoogroups.com, "Corri" virtuous_gracious@
      > wrote:
      > >
      > > What is the "appropriate" way to bill bilateral injections? It seems
      > like one insurance wants it one way, another wants it another. For
      > example Blue Cross wants 20510 with Modifier 50 units=1 and double the
      > price (if you billed $100 per injection then you bill $200). CMS looks
      > like it wants the units doubled as well as a 50 modifier. Can anyone
      > tell me what is correct?
      > >
      > > many many thanks,
      > > Corri
      > >
      >
      > [Non-text portions of this message have been removed]
      >
      >
      >
      >
      >
      >
      >
      > [Non-text portions of this message have been removed]
      >




      [Non-text portions of this message have been removed]
    • Corri Baker
      Thank You Melinda! Very helpful information :) Corri ________________________________ From: Melinda To:
      Message 2 of 5 , Nov 9, 2010
      • 0 Attachment
        Thank You Melinda!
        Very helpful information :)

        Corri




        ________________________________
        From: Melinda <melindadocsmith@...>
        To: MedicalBillers@yahoogroups.com
        Sent: Tue, November 9, 2010 12:35:03 PM
        Subject: [MedicalBillers] Re: Bilateral Injections



        Medicare B News Issue 203 April 21 2003

        Injection Codes Billed Bilaterally- 20600, 20605 and 20610 Bilateral
        procedures are those which are performed on both sides of the body
        during the same session or on the same day. Modifier 50 is not
        applicable to procedures that are bilateral by definition or procedures
        that include the term "bilateral" in their descriptions. In the Medicare
        Physician Fee Schedule Data Base (MPFSDB), the procedure codes with the
        bilateral surgery indicator of 1 can be billed with modifier 50. (This
        is the key information right here. Check your Fee Schedule to see if
        it's billed with Mod 50 or not, by the bilateral surgery indicator of 1)

        Paper claims should be submitted with modifier 50 in Item 24d on the
        HCFA 1500 claim form (or the electronic equivalent) if services are
        being done bilaterally. If more than two modifiers are already reported
        and additional modifiers are needed, they should be submitted in the
        comment field, Item 19 or the electronic equivalent. Noridian has been
        receiving a large number of claims where modifier 50 is being billed
        incorrectly. Some examples follow:

        Example: Injection of both knees

        Incorrect Billing:

        Procedure Codes Units of Service

        20610 LT 1

        20610RT50 1

        This would be saying that you had performed arthrocentesis, aspiration
        and/or injection in three major joints or bursa.

        Incorrect Billing: 20610 50 2

        OR

        Incorrect Billing: 20610 50 1

        20610 50 1

        This would be saying that you had performed arthrocentesis, aspiration
        and/or injection in four major joints or bursa.

        Correct Billing: 20610 LT 1

        20610 RT 1

        OR

        Correct Billing: 20610 50 1

        This would indicate two major joints or bursa.

        NOTE: The diagnosis should correlate with the site of the
        aspiration/injection.

        Example: Injection of both knees and both shoulders

        Billing: 20610 50 2

        This would be correct, however, only one diagnosis can be used. If, for
        example, diagnosis 715.16 (osteoarthritis of the knee) were used, it
        would apply to the knee injections, but not the shoulder injections.
        Therefore, billing reflects injection of four knees.

        Appropriate Billing: 20610 50 1

        20610 50 1

        Each diagnosis should correlate with the site of the
        aspiration/injection. Billing on two lines allows billing the correct
        diagnosis for the knees on one line and the shoulders on the other.

        The payment amount for these bilateral procedures is 150% of the fee
        schedule. The limiting charge is 150% of the established limiting charge
        for one service.

        Note: Do not put spaces or extraneous marks such as "-" or "/" between
        the CPT code and any modifiers.

        Improper claim submission may cause a delay or denial in the processing
        of your claims.

        Applies to the states of: AK, AZ, CO, HI, IA, ND, NV, OR, SD, WA & WY.

        Posted on: 04/21/2003

        http://bbnor.noridian.com/Bulletins/Medicare_Part_B/Medicare_B_News_Bulletins_and_LMRPs-LCDs_(1994_to_Current)/Medicare_B_News_Issue_203_April_2\

        2_2003/Injection_Codes_Billed_Bilaterally_20600_20605_and_20610.htm
        <http://bbnor.noridian.com/Bulletins/Medicare_Part_B/Medicare_B_News_Bulletins_and_LMRPs-LCDs_(1994_to_Current)/Medicare_B_News_Issue_203_April_\

        22_2003/Injection_Codes_Billed_Bilaterally_20600_20605_and_20610.htm>

        --- In MedicalBillers@yahoogroups.com, Corri Baker
        <virtuous_gracious@...> wrote:
        >
        > Melinda,
        > I couldn't get the links to work. Would you please send them again?
        > Thanks,
        > Corri
        >
        >
        >
        >
        > ________________________________
        > From: Melinda melindadocsmith@...
        > To: MedicalBillers@yahoogroups.com
        > Sent: Tue, November 9, 2010 9:20:23 AM
        > Subject: [MedicalBillers] Re: Bilateral Injections
        >
        >
        >
        > Corri,
        >
        > This is how I've always bill Medicare and my bilateral procedures have
        > been paid correctly. I use this guideance for all my payers, unless
        > they publish a coding bulletin stating otherwise.
        >
        >
        http://bbnor.noridian.com/Bulletins/Medicare_Part_B/Medicare_B_News_Bull\
        etins_and_LMRPs-LCDs_(1994_to_Current)/Medicare_B_News_Issue_203_April_2\
        \
        >
        > 2_2003/Injection_Codes_Billed_Bilaterally_20600_20605_and_20610.htm
        >
        <http://bbnor.noridian.com/Bulletins/Medicare_Part_B/Medicare_B_News_Bul\
        letins_and_LMRPs-LCDs_(1994_to_Current)/Medicare_B_News_Issue_203_April_\
        \
        >
        > 22_2003/Injection_Codes_Billed_Bilaterally_20600_20605_and_20610.htm>
        >
        > Melinda Brown, CMBS
        > Ins Biller
        >
        > --- In MedicalBillers@yahoogroups.com, "Corri" virtuous_gracious@
        > wrote:
        > >
        > > What is the "appropriate" way to bill bilateral injections? It seems
        > like one insurance wants it one way, another wants it another. For
        > example Blue Cross wants 20510 with Modifier 50 units=1 and double the
        > price (if you billed $100 per injection then you bill $200). CMS looks
        > like it wants the units doubled as well as a 50 modifier. Can anyone
        > tell me what is correct?
        > >
        > > many many thanks,
        > > Corri
        > >
        >
        > [Non-text portions of this message have been removed]
        >
        >
        >
        >
        >
        >
        >
        > [Non-text portions of this message have been removed]
        >

        [Non-text portions of this message have been removed]







        [Non-text portions of this message have been removed]
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