Modifier -50 is used to indicate that a procedure has been performed on both sides of the body during the same operative session. However, the modifier can present challenges to coders who are unsure about which specific procedures its use applies to.
Dawn Waibel, director of operations at Serbin Surgery Center Billing, and Laurie Spinner, compliance and quality improvement specialist at SCB, provide two tips for using modifier -50.
1. Do not add modifier -50 to procedures that are, by definition, bilateral. One of the biggest mistakes made by coders concerning the use of this modifier is adding it to procedures that are already understood as bilateral, says Ms. Waibel. For example, CPT 58671 (occlusion of oviducts by device) should not include modifier -50 as the procedure is the occlusion of both oviducts, therefore making it bilateral.
2. Make sure that how you report the modifier meets the payor’s guidelines. The proper way to report a bilateral procedure varies by state and payor, according to Ms. Spinner. Although most payors call for straightforward use of modifier -50, reported after the CPT code on one line, some may prefer that the modifier is reported on two separate lines. Typically, a “1” in the unit box is used after the modifier; however some payors may require the use of a “2” in the unit box. Therefore, it is important that coders know the reporting preferences of each payor so that claims are not denied due to coding errors.
Learn more about Serbin Surgery Center Billing.
The information provided should be utilized for educational purposes only. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
