Bilateral Procedures

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June 9, 2016

Question:
Our current billing service is using the 50 modifier when we indicate that it is a bilateral procedure for tubes and sinus procedures. However, they are doubling the amount charged when billing for tubes (69436-50) but not for the sinuses. Can you advise me of the proper way for this to be billed?

Answer:
Anytime bilateral procedures are reported on one line (e.g., 69436-50 or 31256-50) the usual fee for the single procedure should be doubled. When the code is billed on two lines (e.g., 69436 then 69436-50 OR 31256 and 31256-50) the single fee is billed twice which equals the double fee. It is not consistent that the billing service would double the fee for tubes but not for other procedures billed bilaterally. This is inconsistent billing and is under-reporting your total charges.

*This response is based on the best information available as of 06/09/16.