Neurology & Pain Management Coding Alert

Question:Medicare denies our claims with codes CPT 20550 and 64450, stating that the number of units exceeds the maximum. How should we complete these claims?Oklahoma SubscriberAnswer:The denials could stem from reporting codes multiple times or reporting incorrect modifiers. Code CPT 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar "fascia"]) applies to single or multiple injections to a single tendon sheath or ligament. If your physician injects the same sheath multiple times, you still report 20550 only once. You can report 20550 multiple times during an encounter only when the physician injects different tendon sheaths. If you report multiple injections, make sure your provider's documentation clearly indicates the separate and distinct tendons injected. You might need to send the procedure note to explain things to the carrier. Physicians sometimes perform 64450 (Injection, anesthetic agent; other peripheral nerve or branch) bilaterally. Verify whether you're reporting a bilateral procedure and need [...]