DecisionHealth, DecisionHealth - 2022 Issue 7 (July)
Use these strategies when a payer inappropriately applies modifier 50 to injection codes
Question: We recently sent a claim to Blue Cross of Alabama that included 20610-LT for a left shoulder diagnosis and 20610-RT for a right knee diagnosis. The payer responded that we should have billed these procedures on one claim line with a 50 modifier (bilateral procedure). We replied that this was not a bilateral procedure, but rather two separate procedures done in two separate joints. The payer then stated that because code 20610 has a bilateral surgery indicator of “1” in the Medicare physician fee schedule, modifier 50 should be used rather than RT/LT. There doesn’t seem to be any way to report a major joint arthrocentesis done on different joints on opposite sides of the body. Is there a way to correct the situation?
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