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Continue to Use Laterality Modifiers Under ICD-10

October 21, 2015:

Although Centers for Medicare and Medicaid Services guidance is clear on the matter, there still seems to be some confusion over whether to use laterality modifiers with HCPCS and CPT procedure codes when the diagnosis code specifies laterality. There have been murmurings lately that modifiers RT, LT, or 50 Bilateral procedure, are unnecessary on the procedure code.

According to CMS guidance: “Implementation of ICD-10-CM will not change the reporting of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes, including CPT/HCPCS modifiers for physician services. While ICD-10-CM codes have expanded detail, including specification of laterality for some conditions, providers will continue to follow CPT and CMS guidance in reporting CPT/HCPCS modifiers for laterality.”

Payment for professional services is computed based on CPT codes and modifiers. Modifiers, including LT, RT, and 50, ensure that correct payment policies are applied. Therefore, ignore advice to skip laterality modifiers: continue to append them to procedure codes, even when the diagnosis codes themselves indicate laterality.

The question has arisen because ICD-10-CM, unlike ICD-9-CM, details right and left side. For instance, bilateral fractures of the tibia used to be reported with just one ICD-9-CM code—the modifier on the procedure code indicated that the fractures were bilateral. In ICD-10-CM, the same fractures would require two diagnosis codes, one specifying the left side and one the right side. Even though the diagnosis codes make it clear the procedure was performed on both sides, the bilateral modifier is still appended to the procedure code.


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