JUL 19, 2016
Billing Bilateral Procedures
Question: I performed bilateral CPT code 67145 Repair of retinal tear on a Medicare patient on the same day. The first claim I submitted was: 67145 –RT, 67145 –LT. When the payer denied it, I resubmitted: 67145 –RT, 67145 -LT-51. The payer also denied the second claim. What is the best way to submit for reimbursement?
Answer: As of April 2013, Medicare Part B requires all bilateral surgical procedures to be submitted as a single line 67145 -50 with a 1 in the unit field and double the charge. Medicare will pay 150 percent of the allowable. By not submitting correctly payment, as you’ve experienced, may be denied or payment may be 100% of the allowable rather than the correct 150%. Commercial payers will vary in their requirements. Some may prefer two lines with -RT and -LT. No need to append modifier -51; most payers’ systems are sophisticated enough to recognize multiple procedures in the same setting.