ACR Radiology Coding Source™ for January-February 2013

The Centers for Medicare and Medicaid notified the AMA’s specialty society CPT advisors that the 2013 Medicare Physician Fee Schedule (MPFS) will be revised to correctly denote that the new carotid angiography codes (36222-36226) will be eligible for a 150 percent payment adjustment for a bilateral procedure. CMS responded to a multispecialty society request stating that the bilateral surgery modifier indicator will be changed at the earliest possible time to allow billing for each side (when appropriate), retroactive to January 1, 2013. This revision was in response to a request from Dr. Donald Denny on behalf of the Society of Interventional Radiology, ACR, American Society of Neuroradiology, and Society of Vascular Surgeons (and with the support from the American Roentgen Ray Society, Radiological Society of North America, American College of Cardiology, American Association of Neurological Surgeons, and Congress of Neurological Surgeons). 

 

The MPFS currently lists a bilateral indicator of “0”, which does not allow for the 150 percent payment adjustment for a bilateral procedure. Currently, if a bilateral procedure is reported with modifier -50 or with modifiers RT and LT, the bilateral procedure will be paid as a unilateral procedure and not the expected 150 percent paid for a bilateral procedure. 

 

Please reference the detailed guidelines published in the CPT® 2013 codebook prior to the 36222-36228 code section, which instruct coders to report bilateral carotid and/or vertebral arterial catheterization and imaging when performed using modifier 50. The MPFS modifier indicator will be changed to “1” which will allow the appropriate bilateral procedure payment of 150 percent by Medicare contractors.