Wiki 20610 when done on two separate sites

midnight1995

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Chapachet, RI
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If someone can give insight this is mainly with Medicare:
20610 is done on knee and shoulder
1.) Billing 20610 two separate lines with RT or LT with the ICD based on the knee/shoulder
a.) the second 20610 was billed with modifier XS
b.) Medicare is denying invalid modifier - than changed modifier to 59 and again denied for invalid modifier.
There is no documentation or guidelines regarding the above and billing modifier 50 bilaterally would be incorrect.
Greatly appreciate any guidelines or should a redetermination be sent with the progress notes.
 
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