APR 24, 2018
Billing Unilateral Services with Bilateral Diagnoses
Question: Commercial payers denied our services when we appended modifiers -RT or -LT, but the diagnosis is a bilateral code. Should we appeal?
Answer: When the CPT code requires modifiers -RT and/or -LT, the laterality of the diagnosis code must match. While the exam may include the bilateral diagnosis, if a test or surgery indicates that it was only performed on one eye, the diagnosis should also reflect the eye that had the service. When a claim is denied, it is as if the payer never received it. Promptly resubmit.
Learn more about modifiers in the 1-Hour Coding Course: Modifiers Made Easy – Your Guide to Correct Coverage.