ICD Q & A

Ask the Experts: May 14, 2015

Question: Can someone please tell me how to bill Medicare for bilateral CPT code 64772? It was denied by Medicare. I billed them the first time using this method 64772-50 64772

Answer:
If the coder wishes to report the fact that a procedure was done bilaterally, the coder should report the CPT code using the following methods:

1. If the code description includes the term "bilateral" or "unilateral or bilateral," there is no need to assign any modifier.

2. If the code description doesn't include the above terms, then the coder may report the CPT code one time with modifier -50.  Example: 64772-50.

3. If the code description doesn't include the above terms and doesn't technically involve a bilateral body part, but was done multiple times, then the coder may report the CPT code the desired number of times with no modifier. Example: 64772, 64772. This is the reporting method I would recommend for 64772 since it technically doesn't describe a procedure that is generally considered unilateral or bilateral, or involving a body part that is paired.

- Christina Benjamin, MA, RHIA, CCS, CCS-P

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