Radiology Coding Alert

Put a little effort into breaking your somatic nerve injection coding habits, and you're sure to see a payoff. Or if your radiologist is new to pain management, be sure you catch this important reimbursement tip from the start.

The scoop: Medicare changed the bilateral status indicator for many somatic nerve injection codes to "1," meaning Medicare will pay for bilateral injections, says Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, principal of MJH Consulting in Denver.

Medicare pays 100 percent of the allowable for the first procedure and 50 percent for the second with modifier 50 (Bilateral procedure).

Previously these codes had a "0" status indicator, which meant that if you reported the code with modifier 50 or with RT (Right side) and LT (Left side), Medicare would pay for a single injection only, Hammer says.

Watch out: These changes apply to Medicare, but other payers may not update their fee schedules until 2009, Hammer says.

Affected codes include those in the somatic nerve range: 64400-64410, 64413-64417 and 64421-64449. All of these codes' descriptors begin with "Injection, anesthetic agent ..."

Example: If the interventional radiologist performs bilateral femoral nerve blocks with guidance, you should report 64447 (Injection, anesthetic agent; femoral nerve, single) with the appropriate modifier for the nerve block. Depending on your payer, you may report 64447-50; 64447 and 64447-50; or 64447-LT and 64447-RT. Medicare would pay about $60 for the first injection and $30 for the second.

Good news: The change's implementation date was April 7, but it's retroactive to Jan. 1.

Resource: You can find the transmittal online, Hammer says, at http://www.cms.hhs.gov/transmittals/downloads/R1482CP.pdf.