tci Outpatient Facility Coding Alert - 2018 Issue 8

Modifiers: Adhere to these Facility-Specific Guidelines when Billing Bilateral Services

Note underlying differences between ASC, outpatient facility bilateral billing. At first glance, modifier 50 (Bilateral Procedure) appears to be one of the few modifiers that isn’t any more complicated than what’s presented on the surface. However, when diving a little deeper into the subject, you’ll find that it’s not only one of the most misunderstood modifiers — but also one of the most improperly utilized. That’s because there are numerous different considerations you must take into account before reporting bilateral procedures — especially when it comes to the Outpatient Prospective Payment System (OPPS) and...

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