01/14/2022

Medicare Denial for Bilateral Bunions

When billing Medicare for bilateral bunions (M21.611 and M21.612) and using 77077-RT and 77077-LT-59, neither gets paid. Why?

Medicare denied the joint surgery because it will only pay for one charge per patient per DOS. However, it is reasonable for the diagnostic service to be performed bilaterally. A corrected claim should be submitted to Medicare for CPT 77077 under the following criteria:

• Only submit one line item for the radiology service
• Only one unit of service should be billed
• The fee that is normally charged should be doubled
• Modifier -50 should be appended to the service
• All diagnosis codes should be linked to the service

Medicare will reimburse a bilateral service if coded with the bullets listed above- bilateral procedures should be billed when applicable for strappings, injections, and other procedures that are performed on both the left & right side.