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Old 07-06-2011, 12:59 PM
NESmith NESmith is offline
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Default Modifier 76 and CPT code 64450

Is it appropriate to use modifier 76 on CPT code 64450? My provider is doing a diagnostic bilateral L5, S1, S2, & S3 dorsal primary ramus injection under fluoroscooic visualization. Claim was billed 64450-507659
64450-507659
64450-507659
Medicare is denying the second and third line as duplicates. Please help.
As always Thanks
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Old 07-06-2011, 11:03 PM
dwaldman dwaldman is offline
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I assume you are describing the lateral branches w/ 3 levels performed bilateral. When billing WPS Medicare J5, I would not be able use 76 modifier on a surgical procedure code and I would not be able to use the 59 modifier on code pairs that are not subject to NCCI edits. So if I was billing this I would have to bill as such

64450-50
64450-50 51 additional note two additional levels performed Bilateral
64450-50 51

The additional note on the claim is important, but this might be the type of procedure that requires an anticipated denial with planned appeal for review that this a per level procedure and not a duplicate.
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