Go Back   AAPC Medical Coding & Billing Forums > Medical Coding > General Discussion
Forum Rules FAQ Members List Calendar Search Today's Posts Mark Forums Read

Reply
 
Thread Tools
  #1  
Old 06-05-2007, 12:02 PM
jenniferg jenniferg is offline
New
 
Join Date: Apr 2007
Posts: 5
jenniferg is on a distinguished road
Default CPT codes 64475 and 64476

If anyone has experience on coding for CPT codes 64475 and 64476, I will appreciate your help.

When billing Medicare, I have a Pain Management provider who does MULTIPLE BILATERAL injections utilizing CPT codes 64475 and 64476. In the past, I used to bill these with a RT and LT modifier along with modifier -76 when multiple injections are done. Medicare has denied stating that the -76 modifier is not applicable for these CPT codes. I have also used strictly the 50 modifier (billing all on one line item for Medicare) for bilateral along with unit values based on how many injections the provider had done on each side, bilaterally. This scenario has also been denied, stating that I am unable to bill multiple units for 64476.

Has anyone encountered this before? Does anyone have experience on how to appropriate bill for CPT codes 64475 and 64476?

Thanks in advance.

Jennifer Gauger, CPC
Coding Department Supervisor
ebix, inc.
jenniferg@ebixinc.com
Reply With Quote
  #2  
Old 06-05-2007, 08:32 PM
donnajrichmond donnajrichmond is offline
True Blue
 
Join Date: Apr 2007
Location: Alexandria, LA
Posts: 517
donnajrichmond is on a distinguished road
Default

Does your carrier have an LCD for facet joint injections? That would be the place to start.
Otherwise, these should be coded with -50 for bilateral injections.
If your carrier is denying with frequency, they may want -59 for the additional levels.
By CPT if 3 levels were injected, for instance L1-L2; L2-L3; L3-L4 bilaterally, you would code 64475-50, 64476-50 x 3.
You could try 64475-50, 64476-50, 64476-50-59, 64476-50-59, but I'd check the LCD first to see how they want them.
77003 would only be coded once
Reply With Quote
  #3  
Old 06-06-2007, 01:10 PM
jenniferg jenniferg is offline
New
 
Join Date: Apr 2007
Posts: 5
jenniferg is on a distinguished road
Default

Thanks for the assistance. I did call our Medicare carrier and they do not have a policy for these codes. I did not try using the -59 modifier, only billing with the -50 modifier X3. This is what they denied as not being able to bill these codes with multi-units.

Thanks for the suggestion of -59. I will try it.

Jennifer Gauger, CPC
Reply With Quote
  #4  
Old 01-08-2009, 01:38 AM
HCCCoder HCCCoder is offline
Guru
 
Join Date: Apr 2007
Location: Woodland Hills, CA
Posts: 120
HCCCoder is on a distinguished road
Default

I was just researching about CPT codes 64475 and 64476 and I found out this thread.
I thought, we can't bill an add-on code with any modifier. Can someone please explain this situation, how come the add on code 64476 can be billed with modifier 50?

Thank you,
Lilit
__________________
CPC CCS
"The true way to render ourselves happy is to love our work and find in it our pleasure."
Reply With Quote
  #5  
Old 01-08-2009, 01:54 AM
magnolia1 magnolia1 is offline
Expert
 
Join Date: Apr 2007
Location: Albany, New York
Posts: 456
magnolia1 is on a distinguished road
Smile

You cannot use modifier "51" with add-on codes.
You can use modifiers that identify the laterality of the procedure(s).

Also, due to the description of 64476 (each add'l level), modifier "59" is not required in these cases.
__________________
Karen Maloney, CPC
Data Quality Specialist
Reply With Quote
  #6  
Old 01-08-2009, 07:09 PM
HCCCoder HCCCoder is offline
Guru
 
Join Date: Apr 2007
Location: Woodland Hills, CA
Posts: 120
HCCCoder is on a distinguished road
Default

Great, thank you very much Karen.
Lilit
__________________
CPC CCS
"The true way to render ourselves happy is to love our work and find in it our pleasure."
Reply With Quote
  #7  
Old 01-08-2009, 10:24 PM
HCCCoder HCCCoder is offline
Guru
 
Join Date: Apr 2007
Location: Woodland Hills, CA
Posts: 120
HCCCoder is on a distinguished road
Default

I have "Bilateral S1 neuroforaminal/sleeve root blocks" and the doctor billed for 64483, 64484-59, is this correct? If not, how is this supposed to be coded?
Thank you,
Lilit
__________________
CPC CCS
"The true way to render ourselves happy is to love our work and find in it our pleasure."
Reply With Quote
  #8  
Old 01-08-2009, 10:38 PM
magnolia1 magnolia1 is offline
Expert
 
Join Date: Apr 2007
Location: Albany, New York
Posts: 456
magnolia1 is on a distinguished road
Smile

This would be coded 64483-50.
__________________
Karen Maloney, CPC
Data Quality Specialist
Reply With Quote
  #9  
Old 01-08-2009, 10:53 PM
HCCCoder HCCCoder is offline
Guru
 
Join Date: Apr 2007
Location: Woodland Hills, CA
Posts: 120
HCCCoder is on a distinguished road
Default

Thank you Karen very much for your response.
Lilit
__________________
CPC CCS
"The true way to render ourselves happy is to love our work and find in it our pleasure."
Reply With Quote
  #10  
Old 01-08-2009, 11:30 PM
magnolia1 magnolia1 is offline
Expert
 
Join Date: Apr 2007
Location: Albany, New York
Posts: 456
magnolia1 is on a distinguished road
Smile

you are very welcome Lilit.
__________________
Karen Maloney, CPC
Data Quality Specialist
Reply With Quote
Reply

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off




Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

All times are GMT -6. The time now is 08:27 AM.

AAPC - Top

Powered by vBulletin® Version 3.8.1
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.
Copyright ©2014, AAPC