Question Bilateral lumbar facet blocks

mandyh

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When coding bilateral lumbar facet blocks L3-4, L4-5, and L5-S1 I use 64493-50, 64494, 64494, 64495, 64495. Most insurance companies are denying the 2nd 64494 and 64495 as duplicates or exceeding number this code can be reported. According to the AMA CPT manual page 439 only code 64493 is the only code you can use modifier -50 on. Is anyone else having this same issue? I'm appealing but no luck so far. They still think they are duplicates. I even attach a copy of the CPT code book page to support this.
 
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Albany
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I have this issue as well and have to appeal with every insurance. I started billing the old way (50 on all lines) to Medicare because I did see a post or documentation that they are not accepting the new way. I append the LT and RT on the 64494 and 64495 and still get denials. I appeal with a copy of the CPT guidelines and some still have not been reprocessed.
 
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Hamilton Township, NJ
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You need to search if a payer has a policy on Modifier 50 and Facet blocks. That information should guide you on how each payer wants their claims submitted. An example is BCBS Modifier 50 Bilateral Guidelines “Please append modifier 50 to the appropriate unilateral code on a single claim line and please indicate one unit in the unit field of that claim line.”
 

mandyh

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You need to search if a payer has a policy on Modifier 50 and Facet blocks. That information should guide you on how each payer wants their claims submitted. An example is BCBS Modifier 50 Bilateral Guidelines “Please append modifier 50 to the appropriate unilateral code on a single claim line and please indicate one unit in the unit field of that claim line.”
ok thanks for that info. I pulled up the modifier 50 bil procedures policy on BCBS so I guess we need to bill that -50 mod on 64494 and 64495 like we used to and not the CPT code on separate lines. I will try that again.
 
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