- Modifiers LT and RT are used to specify procedures performed on the left and right side of the body. For example, if a patient complained of bilateral ankle pain and a radiologist read films of both the left and right ankle, the correct coding would be 73600-LT for the left ankle and 73600-RT for the right ankle. Some private insurance payers do not recognize the LT and RT modifiers. These insurance companies may require the use of a single code with modifier 50 appended to the procedure code to denote a bilateral procedure.
- Modifier 52 is used to denote reduced services. Many procedural codes include multiple services. If a physician does not perform all services included in a code's description, then modifier 52 is added for reduced reimbursement.
- Modifier 51 indicates multiple procedures performed by the same physician on the same day. For example, if a patient is involved in an automobile accident and received imaging services on the right lower arm and the right ankle, 73090 for the forearm X-ray and 73600-51 for the right ankle X-ray would be coded.
- Reimbursement codes usually include payment for the use of the facilities and for the physician's professional services. In the event that a physician provides services using someone else's facilities, modifier 26 is added to the billing code. For example, if a physician treats a patient in an emergency room, the hospital will bill for the facility fee, while the physician will bill for his service with a 26 modifier.
- Caring for infants requires extra time and expertise. Procedures that are performed on an infant are billed with the modifier 63 to increase the amount of reimbursement that the insurance payer will consider. Not all payers recognize this code, so know the rules for each payer before applying this modifier.
