50 - JE Part A

Definition

Bilateral Procedure

Appropriate Usage

• Append when code description does not already state procedure is bilateral
• Append on bilateral body organs, such as kidneys and ureters.
• Append when performing a procedure bilaterally during one session and Medicare Physician Fee Schedule (MPFS) BILAT SURG indicator is 1 or 3
• Report codes with a BILAT SURG indicator of 1 on one line, append this modifier and submit one unit of service
• Report Codes with a BILAT SURG
  • Submit on one line appending either modifier 50 or RT and LT using one unit of service or
  • Submit on one line using two units of service or
  • Submit on two lines of service using RT on one line and LT on other with one unit of service each

Inappropriate Usage

• Appending when performing service on different areas of same side of body
• Appending when BILAT SURG indicator is 0, 2, or 9
• Appending when removing a lesion on right arm and one on left arm
• Appending on multiple procedures on one organ, such as skin
• Appending on a procedure code that is described as bilateral or unilateral in its CPT description
• Billing bilateral procedure on two lines of service and appending modifier 50 to second line of service

Resources

• CMS Internet Only Manual (IOM), Medicare Claims Processing Manual, Publication 100-04, Chapter 4, section 250.11
• National Correct Coding Initiative Edits