Wiki Billing Intercostal NB 64420 & 64421

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Chesterfield, MO
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Is anyone having trouble getting paid for intercostal nerve blocks? I bill for an ASC and the physician did intercostal nerve block at 4 levels, I billed 64420 and 64421 with 3 units. The insurance, UHC Medicare, denied pmt on 64420. I looked up the NCCI edit and it states that 64420 is a column 2 code for 64421. My question is what modifier to use. I know 59 would not be appropriate because it's not a distinct procedure and the CPT code book states to use 64421 in conjunction with 64420 what multiple nerves are injected.
 
-59 would be correct. Definition of the modifier states different session, procedure site, or organ system. This would be an instance of different site
 
64420 is the primary code and 64421 is an add on code for each additional level beyond the first level represented by 64420 so modifier 59 would not be appropriate on either code. (Per Codify there are also no NCCI edits on the two codes billed together). There is an MUE of 3 on code 64421. If the insurance denied payment on the primary procedure code but not the add-on codes, I would appeal the claim. Did you use your laterality modifiers on both codes? Maybe that contributed to the denial?
 
If the surgeon performed the nerve block with a procedure, it's bundled and not separately billable. If the block is all that was performed, you will may need to check the diagnosis coding and appeal it.
 
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