Wiki 64625 How to bill?

[schanderson]

I am new to pain management billing, so I apologize if it is a simple answer. my physician does a 64625, but what about the other levels that he does? Do I bill for multiple levels with the one code or do I include the 64640 for the additional levels that are done? He does and ablation and injection to multiple joints. Please help me by pointing me in the right direction. Much appreciated for your direction.

Confused in MI

 

[amelia77]

Here's some helpful information for you...I attended a seminar and received this information. Hope this helps. I'm in pain management and have been billing for over 7 years if you need any other help I can try to help you. :0)

 

[amelia77]

I am new to pain management billing, so I apologize if it is a simple answer. my physician does a 64625, but what about the other levels that he does? Do I bill for multiple levels with the one code or do I include the 64640 for the additional levels that are done? He does and ablation and injection to multiple joints. Please help me by pointing me in the right direction. Much appreciated for your direction.

Confused in MI

Forgot to mention I'm in Louisiana :0)

 

[SharonCollachi]

Can you list out what exactly he did and in what locations?

 

[schanderson]

Can you list out what exactly he did and in what locations?

I cannot because the insurance did not approve of the 64625 saying it is experimental. If he has multiple levels can he bill for more than 1 64625 or does he just add on the 64640 for the additional level? Basically, he was asking when he treats the patient can he bill for all the levels actually done or is it something he just has to eat.

 

[bdcoyne8]

It all depends on the levels he ablated. 64625 is for the sacroiliac levels (S1-S5). If he ablated the lumbar spine, it would be 64635. Thoracic and cervical 64633. If he does both sacral and lumbar, you can only bill for one. You can't bill both 64625 and 64635. If the main intent was to ablate the sacral region, it would be 64625. You can also only code this once as it has an MUE of 1. This does not have the add on codes like the 64633 and 64635. If he ablated S1-S3, it would be billed with the 64625 and supporting dx code. You cannot add 64640 for each level as there are specific codes for the spine (64625, 64633, 64635) 64640 is for body areas that do not have a more specific CPT.
Let me know if you have any other questions! I too work for a Pain and Spine specialty.

 

[schanderson]

It all depends on the levels he ablated. 64625 is for the sacroiliac levels (S1-S5). If he ablated the lumbar spine, it would be 64635. Thoracic and cervical 64633. If he does both sacral and lumbar, you can only bill for one. You can't bill both 64625 and 64635. If the main intent was to ablate the sacral region, it would be 64625. You can also only code this once as it has an MUE of 1. This does not have the add on codes like the 64633 and 64635. If he ablated S1-S3, it would be billed with the 64625 and supporting dx code. You cannot add 64640 for each level as there are specific codes for the spine (64625, 64633, 64635) 64640 is for body areas that do not have a more specific CPT.
Let me know if you have any other questions! I too work for a Pain and Spine specialty.

Thank you so much!! I am new to this type of coding and had no other biller/coder brain to pick. I appreciate it.

 

[Bobby A]

ok so according to what you are all saying I cannot bill both 64625 & 64635? Why does the CCI Edits have a yes for modifier if appropriate (which I am taking as 2 separate areas).
My Operate note:

POSTOPERATIVE DIAGNOSIS:
LEFT CHRONIC SACROILIITIS.

PROCEDURE PERFORMED:
Left sacroiliac joint radiofrequency ablation with ablation of the left L4 and L5 medial branches and left lateral branches at S1, S2 and S3 under fluoroscopic guidance with moderate sedation.


INDICATION:
Left chronic sacroiliitis and pain not responding to more conservative measures with brief but significant relief from sacroiliac joint steroid injections.

DESCRIPTION OF PROCEDURE:
The patient was evaluated prior to procedure start time and considered to be an appropriate candidate for moderate sedation. After a no exhaustive list of risks, benefits and alternatives were explained to the patient, all questions were answered and informed consent was obtained. The patient was transferred to the operative suite and placed in the prone position. Standard monitors were applied. The lumbosacral skin was prepared and draped in sterile fashion using ChloraPrep which was allowed to dry. Sterile towels were applied to create a sterile field. An 18-gauge needle was used as a skin marker to identify the left L4, and L5 medial branches as well as the left lateral branches of S1, S2 and S3. A 20-gauge 10 cm insulated radiofrequency needle with a 10 mm curved tip was inserted at each level and advanced under intermittent fluoroscopic imaging until bone was contacted at target points. Lateral fluoroscopy showed appropriate needle depth. Aspiration was negative at each level.
Radiofrequency probes were inserted and testing was performed. Impedances were measured, as well as the motor stimulation where the patient first experienced stimulation. Impedances were seen to be within normal limits. Motor stimulation was seen only in the back or buttock. There was no stimulation into the lower extremity. After testing was considered appropriate, each probe was temporarily removed. Each needle was injected with lidocaine 1% in the amount 1 mL at each level. The probes were reinserted and radiofrequency ablation was performed at 80 degrees Celsius for 90 seconds. The patient tolerated this well. The probes and needles were then removed. Sterile dressing was applied. The patient was transported to recovery in stable condition.

 

[DBARON]

Did you ever get an answer about adding your modifier?

 

[nyckimmie]

Hi, I too am wondering about adding mod 59 to 64635. a different area would fit the criteria for mod 59 but any coding advice I come across (as well as CPT instruction) says do not report 64625 in conjunction with 64635... CPT Assist. Dec. 2019 gives a clinical example and description of 64625 in where the L5 dorsal ramus nerve RFA is included in 64625. I see the medial branches are from the dorsal rami so I code the whole procedure as 64635. My Op heading is the same as Bobby's above. I've studied the anatomy and still don't see the rationale of bundling the 2 codes. If anyone has an info to add, I would appreciate it. thanks!

 

[erinalbert1]

Thank you so much!! I am new to this type of coding and had no other biller/coder brain to pick. I appreciate it.

I am also new to coding and am wondering about a procedure that one of my physicians did. He performed an RFA on L3, L4, L5, S1, and S2. I know you can't use 64625 and 64635 together but I'm confused on how to get my doctor paid correctly? Should there be a modifier on one of the codes? Please help!

 

[afaustina1]

Hi, I too am wondering about adding mod 59 to 64635. a different area would fit the criteria for mod 59 but any coding advice I come across (as well as CPT instruction) says do not report 64625 in conjunction with 64635... CPT Assist. Dec. 2019 gives a clinical example and description of 64625 in where the L5 dorsal ramus nerve RFA is included in 64625. I see the medial branches are from the dorsal rami so I code the whole procedure as 64635. My Op heading is the same as Bobby's above. I've studied the anatomy and still don't see the rationale of bundling the 2 codes. If anyone has an info to add, I would appreciate it. thanks!

Hi, you are correct that 64635 and 64625 cannot be billed together. I do use modifier 59 for RF of facet joints to indicate additional or separate area:
64635-50, 64636-50, 64636-50-59
64633-50, 64634-50, 64634-50-59
If unilateral leave off the 50 modifier.

V. Marie de Zerne, CPC

 

[afaustina1]

Hi, you are correct that 64635 and 64625 cannot be billed together. I do use modifier 59 for RF of facet joints to indicate additional or separate area:
64635-50, 64636-50, 64636-50-59
64633-50, 64634-50, 64634-50-59
If unilateral leave off the 50 modifier.

V. Marie de Zerne, CPC

The 59 modifier would only be added to the 64636 or the 64634 because those are the codes for "each additional level." The 64635 and the 64633 are for first levels.

 

[sanban95@outlook.com]

Can anyone please help? PROCEDURES: RFA Lumbosacral branch LEFT L5 S1 S2 S3 -- INDICATIONS FOR PROCEDURE: see assessment. PROCEDURES PERFORMED: 1. Lumbar Radiofrequency denervation on the LEFT dorsal primary ramus of L5, and lateral branches of S1, S2, S3 fluoroscopically guided. 2. Monitored anesthesia care. See intraoperative record for details. DESCRIPTION OF PROCEDURE: The patient was placed in the prone position. Physiologic monitoring was done throughout the procedure. Sterile preparation was provided with a sterile scrub and sterile drape. Local anesthesia was provided with 1 cc of 1% Lidocaine at the injection site. Under fluoroscopic guidance, on the LEFT, the transition zone between the supraarticular process of S1 and the sacral ala, and the lateral aspects of S1, S2, and S3 neuroforamen between the neuroforamen and sacroiliac joint were identified. Under direct fluoroscopic view, 18-gauge radiofrequency cannulae were advanced down to these anatomic landmarks. AP and oblique/lateral views were utilized to confirm localization. Electrical stimulation testing was performed at each level. No major motor stimulation was noted in the ipsilateral lower extremity. Bipolar technique was utilized. Under AP view, radio-opaque dye was instilled to insure no vascular uptake. The area was then infiltrated with a total of 4 cc of 1% Lidocaine, and 1 cc of Kenalog 40mg/cc. Radiofrequency denervation was provided at 80 degrees centigrade for 90 seconds. Bipolar technique was utilized. After completion of radiofrequency therapy, the needles were removed and good hemostasis noted. The patient tolerated the procedure well without any immediate complication. The patient was monitored for post procedure stability until discharge criteria were met. They will follow up as arranged. Billed originally 64635, 64636, 64636 then was corrected to 64625 now denied experimental. What can I do to correct and have this paid?