Modifier 50 Well To Sail Past Cpc Exam Passing Score

If you've chanced upon sample CPC exam questions, you will have seen questions that ask the examinees to choose between a code that has modifier 50 appended and the same code without modifier 50. As such, being well-versed with CPT's modifier 50 rules can help you spot the ‘wrong, wrong, dead-wrong' choice in multiple choice questions and zoom in on the correct answer whilst helping you get past the CPC exam passing score.

You should append modifier 50 to describe situations in which the physician performs a procedure bilaterally and the descriptor for the best available CPT code doesn't already describe the procedure as bilateral. You increase the reimbursement to 150 percent of the usual allowable fee schedule amount for most payers.

But remember that every code is not eligible for reimbursement with modifier 50. For instance, a physician would never perform a bilateral colonoscopy or cholecystectomy because the patient has only one colon and one gallbladder.

Again, most integumentary codes won't take a modifier 50. That is owing to the fact that the integumentary system codes are mostly about one big organ — the skin.

In real life, Medicare Physician Fee Schedule gives coders a lot of information about when modifier 50 is appropriate and when it is not. During the exam, you'll only have your coding books as references. They will provide all the clues you need to answer modifier 50 questions.

If one of the following conditions apply, you'll know modifier 50 is definitely inappropriate:

• The code descriptor in the CPT book specially states that the procedure is bilateral

• The code descriptor in your CPT book lays down that the physician may perform the procedure either unilaterally or bilaterally.

For instance, the descriptor for code 42507 already includes the term bilateral which means that this is an inherently bilateral procedure. As such, you need not append modifier 50 when reporting this code.

Tip: If modifier 50 figures in some of the multiple choice questions, check the code descriptors in the choices carefully. If the word ‘bilateral' is in a choice, you can quickly strike it out as a possible answer.