Ask a Rev Cycle Expert: CPT® 73562 and Modifier 50?
Question:
We are not receiving the correct reimbursement when we are reporting bilateral knee x-rays with Current Procedural Terminology (CPT®) code 73562 Radiologic examination, knee; 3 views with modifier 50 Bilateral Procedure. The payer is stating that the CPT® can’t be reported with that modifier. Could you shed some light on this?
Answer:
The Centers for Medicare & Medicaid Services (CMS) generally says that modifier 50 Bilateral Procedure may be reported on “paired” organs/body systems, such as eyes, ears, nose, knees. CMS instructions on modifier 50 state that the line item contain the CPT® code, the modifier, unit of service 1, and your charge for the bilateral procedure.
It is important to remember that the medical necessity or clinical indication for the bilateral knee x-rays is a component of this process, as well as other billing rules. For example, if the second knee is being imaged for comparative purposes, then it is not appropriate to report the second study. Be sure to check the payer’s policy to understand their adjudication process.
Disclaimer: This information was current at the time of its publishing and is designed to provide accurate information in regard to the subject matter covered. Vitalware does not accept any responsibility or liability with regard to any errors, omissions, misuses, or misinterpretation by the reader. It is not intended to take the place of either the written policies or regulations. We encourage you to review the specific regulations and other interpretive materials as necessary. All CPT® codes are trademarked by the American Medical Association (AMA) and all revenue codes are copyrighted by the American Hospital Association (AHA).