Author Topic: Bilateral MRIs done in different sessions?  (Read 1035 times)

zakassam

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Bilateral MRIs done in different sessions?
« on: May 09, 2013, 06:27:36 PM »
How do I bill a bilateral MRI for United Healthcare, when each procedure is done two days apart i.e."04/22/2013 (LEFT) and 04/24/2013 (RT)"? when procedures are done on the same day, the carrier states to put the item on one line with modifier 50, and put the total charge for two procedures listed as one unit. It doesn't specify how it is to be used on different days though.

thanks

RichardP

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Re: Bilateral MRIs done in different sessions?
« Reply #1 on: May 10, 2013, 11:58:35 AM »
Zak - I don't bill for MRI's so others will be more knowledgeable about this than I am.  However, doesn't bi-lateral mean two different views taken during the same session?  Your views were not taken in the same session, so I don't see how they could be classified as bi-lateral.  I would think you would bill for two different unilateral sessions, one on each of two different days.  However, there is this:

From here:  http://www.aapc.com/memberarea/forums/showthread.php?t=32010

From a CPT coding perspective, the use of modifier 50, Bilateral procedure, is generally not recommended when bilateral radiology examinations are reported. Rather, the appropriate radiology code is listed twice on the claim form.

In addition, third-party payer reporting guidelines may differ. For example, the HCPCS Level II modifiers RT and LT may be required, or other specific reporting policies have been established, such as reporting the code as a one-line entry on the claim form with a "2" in the units field. Therefore, it is always important to verify the specific reporting requirements for bilateral radiological examinations with the respective third-party payers.


Perhaps you should ask UHC what their specific requirements are for your specific situation.