| If you've chanced upon sample CPC exam questions, | | | | organ — the skin. |
| you will have seen questions that ask the examinees | | | | In real life, Medicare Physician Fee Schedule gives |
| to choose between a code that has modifier 50 | | | | coders a lot of information about when modifier 50 is |
| appended and the same code without modifier 50. As | | | | appropriate and when it is not. During the exam, you'll |
| such, being well-versed with CPT's modifier 50 rules | | | | only have your coding books as references. They will |
| can help you spot the ‘wrong, wrong, dead-wrong' | | | | provide all the clues you need to answer modifier 50 |
| choice in multiple choice questions and zoom in on the | | | | questions. |
| correct answer whilst helping you get past the CPC | | | | If one of the following conditions apply, you'll know |
| exam passing score. | | | | modifier 50 is definitely inappropriate: |
| You should append modifier 50 to describe situations in | | | | • The code descriptor in the CPT book specially |
| which the physician performs a procedure bilaterally | | | | states that the procedure is bilateral |
| and the descriptor for the best available CPT code | | | | • The code descriptor in your CPT book lays down |
| doesn't already describe the procedure as bilateral. | | | | that the physician may perform the procedure either |
| You increase the reimbursement to 150 percent of the | | | | unilaterally or bilaterally. |
| usual allowable fee schedule amount for most payers. | | | | For instance, the descriptor for code 42507 already |
| But remember that every code is not eligible for | | | | includes the term bilateral which means that this is an |
| reimbursement with modifier 50. For instance, a | | | | inherently bilateral procedure. As such, you need not |
| physician would never perform a bilateral colonoscopy | | | | append modifier 50 when reporting this code. |
| or cholecystectomy because the patient has only one | | | | Tip: If modifier 50 figures in some of the multiple choice |
| colon and one gallbladder. | | | | questions, check the code descriptors in the choices |
| Again, most integumentary codes won't take a | | | | carefully. If the word ‘bilateral' is in a choice, you can |
| modifier 50. That is owing to the fact that the | | | | quickly strike it out as a possible answer. |
| integumentary system codes are mostly about one big | | | | |