Wiki -59 not valid with 77003??

Create Wiki
D

diane1217

Networker
Messages
56
Location
Simi Valley, CA
Best answers
0
Anyone know since when is modifier -59 no longer valid with 77003? :confused: We're coding:
64483
62311-59
77003-26-59

The 64483 and 62311 are done at separate levels. Blue Shield is denying the 77003 stating the -59 modifier is invalid for that code. Any insight would be greatly appreciated!! Thanks in advance for your help!
 
I would reference CMS NCCI edits, per Medicare a modifier is allowed to override for just this instance when it's performed for a separate anatomical location. Try and appeal with that info, see if it works. Other than that, not sure?
 
It is the same anatomical area - both are done in the lumbar region; however, the 64483 is done at L2-L3 and the 62311 is done at L4-L5.....
 
Before many of the pain management procedures had fluoro included and required. AMA stated that fluoroscopic guidance is reported per spinal region (ie, cervical, thoracic, lumbar) Later the NCCI policy manual released a statement that fluoroscopic guidance CPT 77003 was reported only once regardless of separate injections or localizations required.

Yes this might represent separate spinal level, but it would be interesting to see the AMA interpretation of there past guidance as reporting fluoroscopic guidance per spinal region, when one of the codes already has fluoroscopic guidance required and valued in its RVUs to report with a similar procedure but a separate approach. They might state they do not support the reporting 62311 and 64483 in the same setting which complicate the situation more. Below is a non-published response from the AMA CPT Network, that might make being able to receive reimbursement for both 62311 and 64483 seem good enough not to also have to pursue 77003

_________________________________________________________________
In which instances would it be appropriate to report codes 64483 and 62311 together?

Answer

Code 62311, Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; lumbar, sacral (caudal), describes epidural or subarachnoid injections of non-neurolytic substances including opioids, steroids, antispasmodic, and anesthetic substances, and does not differentiate between types of substances injected, but rather focuses on the route of administration (ie, single injection [not via indwelling catheter] versus continuous infusion or intermittent bolus via catheter). However, it is important to recognize that code 62311 excludes injection/infusion of a neurolytic substance, which is reported by codes 62280-62282. Therefore, based on the above information and in answer to your specific question, since code 62311 includes the injection of non-neurolytic substances, it would not be appropriate to separately report code 64483, Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level.
 
Oh ok, yeah since it's the same spinal region and fluoro is billed per region, not level then the 59 mod would not be appropriate here. If however the transforaminal injection was lumbar and the epidural was cervical or thoracic, then the 59 could be appropriate. However the information dwaldman posted could effect things as well. Based on that I would probably be happy with getting both injections paid.
 
You must log in or register to reply here.
Top