Botox injections, nerve blocks and M. 59

[ollielooya]

Doctor performs these procedures in his office on same date of service: 64612, 64613, 64405, 64400 and accompanying HCPC codes. According to the CCI edits the only way to correctly unbundle the nerve blocks 64405 and 64400 from the botox injection codes of 64612 and 64613 would be to use the modifier 59. But I can't do this IF these procedures are performed in the same anatomical area, i.e., the neck and facial muscles? Can someone provide an example where one could unbundle and use 64612, 64613, 64405-59, 64400-59? Must this be written off??? What are the best reference materials to use when deciding how this may best apply to these particular situations..---Suzanne

[ElenaWaites]

Do you have a copy of the NCCI Edits?? This will clearly assist you regarding how you may be able to unbundle these codes.

[ollielooya]

Elena, yes, I do and it's still not providing a clear picture of whether or not I may do so, in regards to the use of 59. I also have use of customcoder, and although it is such a very helpful and useful tool, does not get into the nuts and bolts of what I am asking here at the forum.

[Anna Weaver]

Originally Posted by ollielooya

Doctor performs these procedures in his office on same date of service: 64612, 64613, 64405, 64400 and accompanying HCPC codes. According to the CCI edits the only way to correctly unbundle the nerve blocks 64405 and 64400 from the botox injection codes of 64612 and 64613 would be to use the modifier 59. But I can't do this IF these procedures are performed in the same anatomical area, i.e., the neck and facial muscles? Can someone provide an example where one could unbundle and use 64612, 64613, 64405-59, 64400-59? Must this be written off??? What are the best reference materials to use when deciding how this may best apply to these particular situations..---Suzanne

In the Specialty study guide Anesthesia 2008 through AAPC there's a section on Nerve blocks bundled with destruction.

It says:
"Although the anesthesiologist often performs a nerve block before performing nerve destruction, the two procedures do not usually happen on the same date of service.
If the anesthesiologist performs a nerve block to a nerve, then injects a neurolytic agent or performs some other nerve destruction to the same nerve on the same day, you should not separately report both procedures. CPT states that the nerve destruction codes "include the injection of other therapeutic agents," And the National Correct Coding Initiative (NCCI) bundles most nerve block and nerve destruction codes."

Does this help?

[ollielooya]

Anna, thank you for the supportive documentation! You submitted, "It says:
"Although the anesthesiologist often performs a nerve block before performing nerve destruction, the two procedures do not usually happen on the same date of service.
If the anesthesiologist performs a nerve block to a nerve, then injects a neurolytic agent or performs some other nerve destruction to the same nerve on the same day, you should not separately report both procedures. CPT states that the nerve destruction codes "include the injection of other therapeutic agents," And the National Correct Coding Initiative (NCCI) bundles most nerve block and nerve destruction codes."

Now, to followup, would you be so kind as to furnish an example as to where payment MIGHT be deemed possible since the last statement indicates the possibility of allowance?" Also, perhaps all insurance companies do not follow these edit guidelines and WOULD pay? Just asking for my own clarification BEFORE making these calls to the carriers! Again, thank you for your submission as it shall send me on MY mission! Suzanne

[Anna Weaver]

Suzanne,
Sorry, I can't give much. I do know, our physician had a patient they did the block on, patient was in recovery and after a couple hours, it was determined the block didn't help, they took the patient immediately back to surgery and did the destruction. In this instance, I submitted both claims, one with a 59 modifier since it's considered inclusive, but it was actually 2 separate sessions in the OR. I haven't heard whether the insurance will pay yet, it was just recent. We may end up sending documentation and appeal. But that's in the future for now. This is the only scenario I know of when a 59 would work. If it happened during the same session, you would just use the most extensive, which would be the destruction.

[ollielooya]

Anna, could you please share the outcome of your situation? I'd really like to know the end results if you wouldn't mind sharing!

[Anna Weaver]

From what I can see right now, it was paid by medicare and by the secondary insurance both. Yeah!!!

[ollielooya]

That is great to know and I'll save this thread for reference. Thanks for sharing the outcome! ---Suzanne