Procedure Code 20610 & Modifier 50
The WPS Medicare Redetermination department is seeing the procedure code 20610 billed incorrectly by the providers with modifier 50.
Based on the Medicare Physician Fee Schedule Database (MPFSDB) for the procedure codes with indicator 1, 150 percent payment adjustment for bilateral procedures applies, if the code is billed with the bilateral modifier-50.
An example of what providers are trying to bill for is two injections sites on the right knee and one injection site on the left knee. In this case, the claim is being billed as follows: line one 20610-50RT and line two 20610-LT. Claims billed in this manner are then being denied for incorrect billing of the code on the system. In this situation choose from one of the examples below for the correct billing.
Example 1: The correct coding of the procedure code would be on one line 20610-RT with 2 in the unit field and on a second line 20610-LT with 1 indicated in the unit field.
Example 2: Bill on one line procedure 20610-RTLT with 3 indicated in the unit field.
Page Last Updated: Tuesday, 15-Jul-2008 10:45:19 CDT
