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Question:
How do I report bilateral procedures, one line or two?
Answer:
Great question, unfortunately the payors have made this simple concept of bilateral procedures challenging from a reimbursement standpoint! Survey your payors and obtain their individual instruction in writing. Even Medicare carriers vary from region to region. For Medicare, check your Carrier Manual or website for their instructions.
The questions to ask are:
1) Does the payor want bilateral procedures reported on one line (linear format)?
2) Does the payor want bilateral procedures reported on two lines (line item reporting)?
3) Does the payor want you to use right and left modifiers instead of the modifier 50?
If the payor prefers the linear format, then the following questions need answers:
A) Do you report one unit or two?
B) Do you submit your fee one time or double?
Example of linear reporting format:
CPT code/modifier Charge Units
27447-50, place a 1 or 1 in the units box based on payor instructions and submit the fees at one or two times your normal fee.
If the payor prefers line item reporting, then use the modifier -50 on the second procedure.
Example of line item reporting format:
CPT code/modifier Charge Units
27447 Submit a 1 in the units box and submit your full fee
27447-50 Submit a 1 in the units box and submit your full fee
In either scenario, watch your reimbursement closely to ensure the payor reimburses 100% for the first procedure and 50% for the second. This scenario assumes one surgeon is performing both procedures independently.
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