Pain Management Coding Alert
Get Payer Advice for Reporting Bilateral GON Block
PDF
Question: I need advice on how to code for Medicare versus commercial payers when reporting 64405 as bilateral. I’ve seen several different ways that coders report it. What kinds of guidelines exist?
Louisiana Subscriber
Answer: When submitting 64405 (Injection, anesthetic agent; greater occipital nerve) as bilateral, Medicare requires that you include modifier 50 (Bilateral procedure) with a single unit of service and one line item.
The correct way to report the service for commercial insurers will depend on the payer. Some want modifier 50, some want you to report separate lines of 64405 with modifiers LT (Left side) and RT (Right side), some want you to include modifier 51 (Multiple procedures) to distinguish bilaterality. Directions for billing bilateral services should be included in the payer’s provider manual.
Pain Management Coding Alert
- Reimbursement:
Follow These 3 Tips to File Successful 'Unlisted' Claims
The better your provider’s documentation, the better your chances at payment. Submitting claims with unlisted [...] - Back to Basics:
Get the Scoop on 3 Everyday Questions From NGS
Tip: Document pain level as part of ROS. A recent “Part B Ask the Contractor” [...] - ICD-10:
Verify the Spinal Location to Choose Your Schmorl's Node Diagnosis
Heads up: Get ready for more choices with ICD-10. “Schmorl’s nodes” might not be a [...] - You Be the Coder:
Take Care When Coding Same-Side Facet Joint Injections
Question: Our specialist administered several facet joint injections and appended modifier 50 to represent multiple levels, [...] - Reader questions:
Get Payer Advice for Reporting Bilateral GON Block
Question: I need advice on how to code for Medicare versus commercial payers when reporting 64405 [...] - Reader questions:
Injection Site Can Point You to Procedure Code
Question: Our physician dictated the following: “patient has irritation of the soft tissues over the left [...] - Reader questions:
Submit J8499 for Migraine Medication Rizatriptan
Question: I can’t find a code for the migraine medication Maxalt, aka Rizatriptan Benzoate, as a [...] - Reader questions:
Include Modifier 32 for Mandated Service
Question: A 40-year-old male came into our office with a work-related back injury. His doctor put [...] - Reader questions:
Search for the Most Definitive Diagnosis, Even With ICD-10
Question: Though there are many crosswalks from ICD-9 to ICD-10, there are many codes that do [...] - Reader questions:
Clear Documentation Can Support Multiple 99212's
Question: I code for a practice that includes multiple specialties (pain management, neurology, internal medicine, and [...]