2013 coding of 64493,64494,64495

[StephanieWard]

We are getting edits at my Pain Mgmt office stating medication needs to be billed with 64493,64494,64495 is this something new in 2013 as we have never billed for the actual medication injected before... Thank you.

 

[sandrasperrazza]

We have always billed the diagnostic or therapeutic agent when perfoming these procedures for years. Some payors will reimburse for the medication and some do not.

 

[StephanieWard]

Thank you ... Im new to the practice and in training never told to bill the agents but I know that we billed such agents etc at where I used to work.. now our software has an edit so I wanted to VERIFY! Thank you

 

[DFlemings]

I am familiar with these pain management procedures. If medication was injected, it would be necessary to bill for these as well. There are instances where an anesthetic is only injected, such as Bupivacaine, which is not reimbursed for most insurances.

 

[mitchellde]

In addition the different medications require different medical necessity, it is a subtle and slight different in dx but can mean the difference in pay or no pay. Many payers are just recently changing their edits for this. So if the drug is for pain you should use a 338.xx code first listed and link to the injection and the drug, if it is therapeutic to the condition then list the condition first and link to the injection. Follow the instructions in the coding guidelines for pain coding.

 

[StephanieWard]

One more question.. what about billing these for an Ambulatory Surg Center, facility charges?? Thanks