AMA CPT® Assistant - 2015 Issue 8 (August)
Modifiers (Q&A) (August 2015)
August 2015 page 8e Modifiers Question: How should a bilateral procedure be reported when the code description only includes the word "unilateral," and there are no bilateral codes? For example, when an ultrasound of both breasts is performed, code 76641 , Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete , is reported; however, should the procedure be reported with modifier 50 as single-line item or as separate line items with an anatomic modifier to indicate each side? Answer: If the term "unilateral" is included in the code description and there is no code for "bilateral"...
Subscribe or sign in to view the full article.
Article Overview
This article explains a modifier-focused billing question in CPT coding and discusses how bilateral procedures may be reported when only a unilateral code is available. It is aimed at coders, billers, and reimbursement staff who need to understand general CPT reporting guidance and how payer requirements can differ from CPT recommendations. The article centers on modifier usage and claim presentation in a simple question-and-answer format.
Why This Topic Matters
Correct reporting of bilateral services affects claim accuracy, consistency with CPT guidance, and payer processing. This short article helps readers understand the broader coding issue without needing a long policy document.
Article Sections
-
Modifiers
A coding question and answer about reporting bilateral procedures under CPT when only unilateral language is present in the code set. The section addresses general reporting approach and notes that payer requirements may differ.
What You Will Learn
- The general CPT topic area addressed by the article
- How bilateral procedure reporting is discussed in a Q&A format
- Why payer-specific reporting expectations may still need to be checked
- What kind of modifier-focused guidance the article provides
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle professionals
- Compliance staff
- Coding educators
Codes Discussed
Modifiers Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com
