Neurosurgery Coding Alert

Question: Our surgeon performed radiofrequency procedure and we reported it with code 64635 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; lumbar or sacral, single facet joint).  The patient returned within 10 days in the global period. Our APRN performed an injection in an office setting and we reported it with 64450 (Injection, anesthetic agent; other peripheral nerve or branch) - 79 (Unrelated procedure or service by the same physician or other qualified health care professional). Our insurance is denying for the global period service and provides explanation that modifier 79 is incorrect. The injection was performed on a different day and on a different body part. Are we not correct for modifier 79 in this case?

Alaska Subscriber

Answer: The radiofrequency procedure 64635 has a ten day global period. Assuming that the peripheral nerve injection 64450 performed in the office was in a different location and for a different diagnosis, you would report the new diagnosis code and the injection code 64450 with the 79 modifier. It would be appropriate to send an appeal letter explaining the new diagnosis and the separate location of the procedure.