Thank you Michelle. There is definitely conflicting responses out there even
with Medicare.
Can anyone else share their experiences with the “bilateral” codes versus
listing a separate LT and RT diagnosis code? ( i.e foot drop – M21.37,
M21.371. M21.372, M21.379)
I spoke to Medicare at length and after several minutes of discussion and
waiting “while she searched” she came back said she cannot give me a
specific response and to ask the referring physician.
It is not cut and dry as to using both the ICD 10 codes for bilateral. She
actually said using the “unspecified’ code would be appropriate if a
“bilateral” code was not listed.
This was the ICD-10 Medicare Customer Service department; she said they are
basically there to help us “find” ICD-10 codes and not give us a specific
answers to questions like this and to call the physician’s office.
We are in Jurisdiction D.
I look forward to hearing any suggestions or comments you may have.
Thank you and have a great day.
Adele
Adele Jeppesen
Practice Administrator
Hittenberger Orthotics and Prosthetics, LLC
181 Lynch Creek Way, Suite 101, Petaluma, CA 94954
500 Doyle Park Drive, Suite 106B, Santa Rosa, CA 95405
1125 Sir Francis Drake Blvd., Suite L, Kentfield, CA 94904
1-707-765-1122
FAX 1-707-765-4571
www.hittenberger.com
—–Original Message—–
From: Orthotics and Prosthetics List [mailto:[email protected]] On
Behalf Of Michelle Jones
Sent: Tuesday, October 06, 2015 7:29 AM
To: [email protected]
Subject: [OANDP-L] ICD-10 Bilateral Codes
Good morning.
I wanted to thank you all for the responses and share with you a response I
received that can be found on the NGSMedicare Jurisdiction B website, in
case anybody would like it in writing:
Here is a clarification from Medicare:
Jurisdiction B Tip of the Week – Billing Clarification for Lateral Modifiers
We have received inquiries regarding ICD-10-CM and billing of items that
require the lateral modifiers. When submitting claims to the Jurisdiction B
Durable Medical Equipment Medicare Administrative Contractor (DME MAC) for
an item described by the same Healthcare Common Procedure Coding System
(HCPCS) code and the item is ordered for the right (RT) and left (LT) side,
you should submit one claim line with the correct HCPCS code with the RT, LT
modifiers appended and bill two units of service. If there are two ICD-10-CM
codes that specify right and left, both diagnosis codes should be submitted
on the claim.
On 9/24/2015, the Centers for Medicare & Medicaid Services (CMS) published
MLN Matters ConnectsR Provider eNews. Implementation of ICD-10-CM will not
change billing guidelines if you are providing items for the right and left
side. While ICD-10-CM codes have expanded detail, including specification of
laterality for some conditions, you will continue to follow Common Procedure
Coding (CPT) and CMS guidance in reporting CPT/HCPCS modifiers for
laterality.
Detailed information regarding coding for ICD-10-CM to report CPT/HCPCS
modifiers for laterality is included in the MLN Matters ConnectsR Provider
eNews.
I believe this has sufficiently answered my question.
Thanks again!!
Michelle Jones, Sr. Insurance Specialist
Progressive Prosthetic & Orthopedic Services, Inc.
380 Cleveland Place
Virginia Beach, VA 23462
Phone: (757) 456-5501
Fax: (757) 671-7525
Email: [email protected]
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