Wiki 62311 billed with 64635

[cyclingjunkie]

CCI edits for 2012 are showing these two procedures cannot be billed together and no modifier is allowed. Could we bill 62311 with a 59 modifier if injection is given at different level than 64635 even if done on the same side?

Right L5-S1 translaminar epidural steroid injection with epidurogram
Right L3-4-5 median branch blcoks with rhizotomies

Any help would be greatly appreciated. Thanks.

 

[purplescarf23]

My instinct says this is probably going to be denied BUT I would agree with you in adding the -59. They are different locations so the provider should not be marked down or not given credit for his/her work. Good luck with this one

Kelsey, CPC

 

[dwaldman]

I would use the opputurnity to show the provider who perform the procedure that epidural and radiofrequency performed during the same session will not allow separate payment for the epidural, so he is aware of this code pair and the restrictions. This is also something you can go over with the precertification department. When looking at future scheduled procedures, this code combination would be something that could make them run thru a CCI check the codes and alert the physician prior to the procedure about the bundling issues.

When no modifier is allowed, I personally don't report the column two procedure with the 59. I just accepted it as a bundled procedure and only report the colunn one code.