Author Topic: Bilateral CPT 69210  (Read 1281 times)

Cpatel

  • Jr. Member
  • **
  • Posts: 51
Bilateral CPT 69210
« on: August 02, 2016, 01:55:29 PM »
Hello,

We are getting rejections from Medicare for 69210 with 50 modifier. Per coding guide 69210 is unilateral CPT and 50 modifier is allowed for bilateral. Am I billing wrong? Anyone is getting same kind of rejections from Medicare? Please advise.


Thanks
Chhaya

kristin

  • Sr. Member
  • ****
  • Posts: 493
Re: Bilateral CPT 69210
« Reply #1 on: August 02, 2016, 07:07:06 PM »
I have seen a lot of discussion about this on another forum, and the last thing I heard was that Medicare will simply not pay for this when done on both ears at the same time. They even put it in the Federal Register. Their stance is that the chances of it being done on both ears is 10% of the time, and they have factored enough RVU's into just billing it once to pay for both ears.

If they have since changed their stance, I have not heard they did. Some other payers have the same stance, I think UHC is one of them.

PMRNC

  • Hero Member
  • *****
  • Posts: 4254
    • One Stop Resources & Networking for Medical Billers
Re: Bilateral CPT 69210
« Reply #2 on: August 03, 2016, 07:07:19 AM »
Kristen is right, most payers follow Medicare guidelines only paying for one ear on one day. My ped's do this procedure quite a bit and very rare they do both ears same day, but I've seen where the provider had the patient come back the next day or within 2 days for the other ear. Occasionally when both ears are bad we will bill for both ears using modifier 50 appended to the second ear (2nd claim line)

 
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Cpatel

  • Jr. Member
  • **
  • Posts: 51
Re: Bilateral CPT 69210
« Reply #3 on: August 26, 2016, 11:03:21 AM »
Thanks for replies. I found on CMS that Medicare has calculated RVU for 69210 at 150% so will only pay for 1 unit.

Thanks