What do you know about laterality modifiers? You cannot skip these modifiers if you have performed a procedure on one of the paired body parts, such as eyes, ears, arms, legs, and even organs. We all know that medical billing isn’t just about submitting timely claims. It is also about specifying everything. RT and LT modifiers help with that!
These two-character laterality codes clarify the location of the performed service, helping you avoid claim denials, compliance issues, or underpayments. But do you know about their billing requirements? Let us guide you in understanding how and when to use these modifiers. Follow our tips to accurately bill for joint injections, imaging, or surgical procedures.
Modifier RT – Description
So, what does modifier RT indicate in medical billing? This laterality modifier reports that a healthcare provider performed a service or procedure on the right side of the body. Do you also think of the modifier RT as a surgical modifier? In reality, you can also apply it to the supplies’ Healthcare Common Procedure Coding System (HCPCS) codes to specify that they are for the right side or structure of the body.
In short, this modifier paints a more detailed picture, helping insurance companies identify procedures or services performed on the right eye, ear, arm, or leg.
Modifier LT – Description
Modifier LT describes the opposite side. In simple words, billing teams use this two-character code when a procedure or service is performed on the left side of the body. You can also use it to report supplies prescribed for the left arm, leg, ankle, or any other left structure.
In short, like RT, modifier LT also ensures accurate claim processing by specifying laterality, helping you avoid denials and duplicate billing issues.
Scenarios Where Modifiers RT & LT are Applicable
Let’s help you learn how to use these modifiers accurately with specific scenarios.
When to Use Modifier RT
Here are a few examples where modifier RT is applicable:
Right Knee Joint Aspiration & Injection
Osteoarthritis is the most common type of arthritis, affecting 73% of people over 55. Out of them, 60% are women. So, let’s consider this scenario! Suppose a 58-year-old woman with osteoarthritis experiences increased swelling and stiffness in her right knee. She visits a primary care clinic seeking medication to reduce inflammation and pain.
The physician evaluates her condition, reviews her medical history, and suspects fluid buildup. He performs joint aspiration without ultrasound guidance and administers an intra-articular injection to reduce inflammation. Since this procedure is performed on the right knee joint, the provider appends modifier RT to CPT code 20610 when filing the claim.
Cataract Surgery on the Right Eye
Now, let’s consider a surgical procedure! Assume a 63-year-old man with diabetes develops a cataract—clouding of the lens—in his right eye. He visits an ophthalmology clinic due to declining vision. After a detailed evaluation, the doctor schedules cataract surgery.
During the operation, the provider removes the cataract using phacoemulsification—a procedure that emulsifies the eye’s internal lens with ultrasonic waves—and inserts an artificial lens. He then applies modifier RT to the procedural code (66984-RT) to indicate that the surgery was performed on the right eye.
Right Wrist-Hand Orthosis
Want to use modifier RT with a durable medical equipment (DME) HCPCS code? Here is how you can do that! A 27-year-old plumber, due to repeated use of percussive tools such as a hammer, chisel, and mallet, experiences numbness and weakness in his right hand. After losing grip strength, he visits an outpatient clinic and is diagnosed with carpal tunnel syndrome.
The doctor prescribes rest and a wrist brace to immobilize the affected hand. He then appends modifier RT to HCPCS code L3908 to indicate that the DME is for the patient’s right wrist.
When to Use Modifier LT
Now, let’s look at some applicable scenarios for modifier LT.
Left Eye Defect Repair
Suppose a child with congenital ptosis (drooping of the eyelid) is brought to an ophthalmologist by his parents. Initially, the doctor considers delaying surgery since the child is only 1 year old. However, due to the severity of the condition, the drooping eyelid impacting the toddler’s vision, the provider decides to proceed with ptosis repair surgery.
He tightens the levator muscle to lift the eyelid and then appends modifier LT to CPT code 67904 to specify that the surgery was performed on the left eye.
Replacement of a Left-Ear Cochlear Implant External Speech Processor
A 60-year-old man with profound sensorineural hearing loss (hearing loss due to inner ear damage) has had bilateral cochlear implants for the past five years. However, his left ear implant’s external speech processor starts malfunctioning, making it difficult to hear intermittent sounds and understand speech.
The man consults his regular otolaryngologist, who confirms the issue and submits a request for a replacement for the said component. The provider then uses the modifier LT with the appropriate HCPCS code (L8627) when filing the claim.
Imaging Service on the Left Knee
Let’s consider a diagnostic test! Suppose a 19-year-old football player arrives with pain in his left knee after getting tackled by opposing team members.
After assessing the knee joint, the doctor suspects a dislocation and orders an X-ray to confirm his diagnosis. The billing team then appends modifier LT to CPT code 73560 to specify that the provider took one or two X-ray images of the left knee joint.
Modifiers RT & LT – Billing Guidelines
By now, you must be quite familiar with RT and LT modifiers and understand how crucial they are for accurate claims processing. The key is to use them appropriately. Want to maximize your reimbursements?
Explore appropriate and inappropriate uses of these laterality modifiers and follow their documentation and payer-specific requirements.
Appropriate Uses of RT & LT Modifiers
Modifiers RT and LT are appropriate only when:
- A service or procedure code (CPT) or an item code (HCPCS) for anatomic structures that can be distinguished as left or right does not specify laterality.
Inappropriate Uses of RT & LT Modifiers
You should avoid using RT and LT modifiers with:
- CPT or HCPCS codes that specifically include “unilateral” or “bilateral” in their description (as they already specify laterality).
- Bilateral procedures that require modifier 50.
- Procedures that are not side-specific.
Documentation Requirements
You should support the use of RT and LT modifiers with proper documentation. This includes recording details such as:
- The side of the body on which you performed the procedure.
- Operative reports
- Progress notes
In short, your documentation should be clear, complete, and concise to prevent insurance companies from rejecting your claims.
Check Payer-Specific Requirements
Insurers have varying policies for almost everything, including RT and LT modifiers. For example, the Centers for Medicare & Medicaid Services (CMS) maintains a list of codes that require laterality modifiers. In simple words? Medicare will reject your claims without the appropriate RT or LT modifier with these codes.
Additionally, Medicare generally prefers Modifier 50 for bilateral procedures. However, some commercial payers may require you to use RT and LT modifiers even for bilateral procedures. Therefore, always verify payer-specific guidelines before submitting a claim.
Summary
To summarize, RT and LT modifiers show laterality. Insurance companies require these modifiers with all those CPT or HCPCS codes that describe services performed on:
- Contralateral anatomic sites like bones and joints
- Paired body parts such as eyes and ears
- Extremities such as arms or legs
- Organs like kidneys or lungs
Otherwise, they can reject your claims for being duplicates. We have covered both RT and LT modifiers in quite detail so you can understand their appropriate uses. In short, you can use the modifier RT if you have performed a service or prescribed an item for the right side of the body. On the other hand, you use the modifier LT if you have addressed the left side of the patient’s body.
Frequently Asked Questions
