Medical Billing Forum

Coding => Coding => Topic started by: DEBILYNR on September 25, 2014, 03:00:51 PM

Title: Billing Medicare for CPT 50590 Lithotripsy
Post by: DEBILYNR on September 25, 2014, 03:00:51 PM
I billed Medicare for a 50590  2 units (Lithotripsy). It was originally denied as being post op. I added a 78 modifier and it was denied for max # of units or procedures performed.  Should I designate right and left or maybe add 50 modifier?

Thank you
Title: Re: Billing Medicare for CPT 50590 Lithotripsy
Post by: Michele on September 26, 2014, 09:00:04 AM
First are you a coder and do you have access to the patient's chart?  You can't add modifiers without knowing if the modifiers are appropriate for the specific case you are billing.  Many billers make the mistake of just adding modifiers to get the claim paid.

With that being said, why are you billing 2 units?  Was it done on more than one organ?  Why would you bill bilateral? 
Title: Re: Billing Medicare for CPT 50590 Lithotripsy
Post by: kristin on September 28, 2014, 04:42:37 PM
If the patient had multiple stones on one side, regardless of where they are(kidney, ureter), you bill 50590 once. So if that is the situation, you now know why Medicare is denying two units. They only allow one unit of 50590 to be billed per DOS.

If, on the other hand, the patient had stones on BOTH sides, and BOTH sides were treated on one DOS, you bill one unit of the 50590, with a 50 modifier. The thing is, this rarely happens, because if a patient should happen to have stones on both sides, the doctor usually does the lithotripsy on one side, then has the patient come back at a later date to have the other side done. Doing both sides at once is rare. But, if that happens to be the case here, you use the 50 modifier, and be prepared to send in operative report and notes to show why both sides were done on the same DOS.

Here is a fairly recent article that backs up what I am saying:

https://www.supercoder.com/my-ask-an-expert/topic/multiple-eswls

I researched this topic personally several years back, when my husband had numerous kidney stones treated via lithotripsy, and the billing department of his urologist's office tried charging multiple units to our insurance company, then wanted us to pay when insurance denied the charges, which I wasn't about to do.
Title: Re: Billing Medicare for CPT 50590 Lithotripsy
Post by: Michele on September 30, 2014, 08:33:09 AM
Thanks for the info Kristin.  I didn't have any personal knowledge but when I read about the code that's what I was thinking.   :D
Title: Re: Billing Medicare for CPT 50590 Lithotripsy
Post by: kristin on September 30, 2014, 08:00:33 PM
You're welcome! I know I was thinking what you were, and suspect that is the issue with the denial the original poster is dealing with.

I just know I will never forget getting an EOB after my husband's surgery with 50590 listed like, seven times, and thinking, "What the...?" LOL!