Author Topic: Trouble w/ billing the same procedure as multiple and bilateral....  (Read 1038 times)


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I have a surgical claim in which the service was performed twice on one foot and a 3rd time on the other.
So it's a multiple surgery as well as bilateral.
It's a HPHC claim and according to their policies I have two rules that apply to a situation like this, but they seem to contradict each other.
Their multiple surgery policy states:Bill the same procedure performed multiple times at the same session on one line with a count
Their bilateral surgery policy states: Bilateral services performed on both sides of the body during the same operative session or on the same day must be billed on a single detail line with CPT and modifier 50 appended

So, what I'm wondering is if I should bill the bilateral service w/ the 50 modifier and 2 units on one line and the 3rd service on a separate line, maybe w/ a 59 modifier and RT to signify that it was a distinctly separate service? 
Is there another way I should bill this?
Any suggestions are VERY welcome :)


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Re: Trouble w/ billing the same procedure as multiple and bilateral....
« Reply #1 on: August 14, 2014, 07:17:53 AM »
I would try it the way you mentioned.  If you are submitting on paper I would include an explanation and the op notes.  Otherwise you will most likely have to file an appeal or adjustment later to have it corrected.
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