Excessive usage of Modifier 50 in Dermatology

Excessive usage of Modifier 50 in Dermatology

Modifiers are codes that provide extra details about a procedure. They are appended to CPT or HCPCS codes to communicate specific details about the performance of a procedure or service. Adding the appropriate dermatology modifier to provide payers with more specificity about the service or procedure rendered will facilitate appropriate reimbursement. Similarly, incorrectly applied dermatology billing modifiers on a claim will result in denials.

Experienced dermatology medical billing and coding services providers can assist practices in filing clean claims by assigning the appropriate codes and modifiers to support the services rendered.

Particularly, a dermatology modifier provides the mechanism to:

  • Report or indicate that a service or procedure was performed and changed as a result of a specific circumstance without changing the meaning of the CPT code.
  • Provide additional information about services that have been performed multiple times or services that have occurred in an unusual manner.
  • Provide information that is not included in the code descriptor.
  • To report codes related to specific payer programs.

Basic Understanding of Modifier 50

The modifier “50” denotes the bilateral nature of a procedure within a single encounter. In fact, the modifier 50 is a payment modifier, not an informational modifier. Depending on the procedure code and the BILAT SURG indicator, the addition of this modifier may affect payment.

The application of bilateral Unna boots, which would be reported as 29580 + 50, is a common scenario for a dermatologist to use this modifier. When removing a lesion on the right arm and one on the left arm, or on the right and left leg, this modifier should not be used. Instead of the “50” modifier, the provider should use the “RT” and “LT” modifiers, or the “XS.”

Modifier 50 – Correct Usage

The appropriate Modifier 50 usage includes:

  • When performing a bilateral procedure in a single session, use modifier 50 and the Medicare Physician Fee Schedule Relative Value File (MPFSRVF), also known as the Medicare Physician Fee Schedule Database (MPFSDB) BILAT SURG indicator is either 1 or 3.
  • Report codes with a BILAT SURG indicator of 1 and 3 by appending modifier 50 and performing the procedure on bilateral body parts on a single line.
  • Modifier 50 is used to report bilateral procedures performed by the same physician during the same operative session in either separate operative areas (e.g., legs, hands, feet, arms, ears) or in the same operative area (e.g., eyes, nose, breasts).
  • When using modifier 50 to indicate a bilaterally performed procedure, do not bill modifiers LT and RT on the same service line. To identify which of the paired organs was operated on, use the modifiers LT or RT. Billing procedures with the LT and RT modifiers as two lines of service is not the same as identifying the procedure with modifier 50. When reporting bilateral procedures, Modifier 50 is the preferred coding practice.

Modifier 50 – Incorrect Usage

The inappropriate Modifier 50 usage includes:

  • When performing the procedure on different areas of the same side of the body, do not use modifier 50.
  • When the BILAT SURG indicator is 0, 2, or 9, do not use modifier 50.
  • Modifier 50 should not be used with a procedure code that is described as bilateral, unilateral, or bilateral in its CPT description.
  • When removing a lesion on the right arm and a lesion on the left arm, do not use modifier 50. Make use of the RT and LT modifiers.
  • Modifier 50 should not be used for procedures involving midline organs such as the bladder, esophagus, uterus, and nasal septum.
  • Do not add modifier 50 to the second line of service when reporting a bilateral procedure on two lines of service.

Consequences of Excessive Usage of Modifier 50

Basic dermatology modifier mistakes can cost your practice hundreds of thousands of dollars in lost revenue. In fact, the government and insurance companies deny claims because of such medical billing and coding mistakes. Until you can correct and resubmit a clean claim, your practices lose reimbursement revenue.

The most common dermatology modifier mistakes result in high denial rates and can jeopardize patient care. However, the more serious consequences of upcoding and acts of excessive use may subject your practice to federal penalties and costly fines.

So, it’s time to start reducing dermatology modifier mistakes, lowering denials and rejected claims, and increasing reimbursements.

Ensure Accurate Usage of Dermatology Modifier!

Every year, the AMA publishes CPT coding guidelines on coding-specific procedures and services. Dermatology modifiers must be used correctly for accurate coding as many modifiers directly affect providers’ reimbursement. Claim denials can result from not using a modifier or from using the incorrect modifier, which can lead to rework, payment delays, and potential reimbursement loss. Incorrect use of a modifier can also result in exceeding the amount payable for a service rendered or receiving payment when payment is not due, both of which can result in heavy fines and penalties if not reported by the practice.

Obtaining professional assistance from Medisys Data Solutions Inc. can help you to ensure that the billing and coding cycle runs smoothly. We employ expert coders who are well-versed in CPT codes and modifiers and can assist you in accurately reporting your services. Our experts will make certain that modifier codes are only reported when they are applicable and supported by specific documentation in the patient’s medical record.

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