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Billing multiple bilateral facet injections

missyah20

Guru
Messages
222
Location
Minneapolis
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0
I have a claim for a patient that had 3 bilateral facet joint injections done. We billed with 3 lines:
64470 - 50
64472 - 50
64472 - 50- 59
Medicare has paid on the first line, but has then denied the 64472 codes with a remark code CO-97(service included in payment/allowance for antoher service procedure that has already been adjudicated).

The medicare contractor for this particular practice is WPS. I have looked at the Paravertrebral Facet injection LCD and didn't see anything wrong with how we are billing also per the article attached to the LCD it states: "Each CPT code listed(single leve, each additional level) may be billed with a Modifier 50 when injecting a level bilaterally."

Has anyone else had any denials like this? Should be be billing this differently?

Thanks!
 

lreese

New
Messages
1
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0
Bilateral Facet Injections

You must bill the add on code on 1 line with 50 modifier and 2 units you will have to adjust the fee based on how your computer system is set up. The second level is modifier 59 exempt.

Leslie Reese Yaung CPC
SpineCarolina
 

pygreen

Expert
Messages
305
Location
Rome, GA
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0
Bilateral facet injections

We are in GA and have had this same issue. We finally got someone at GA Medicare to clarify how they want us to bill these charges. They want the units billed as separate line items with Modifier 59 on the 2nd add on code. It took us several months to get this issue resolved. We did have to do corrected claims.

Peggy Y. Green, CPC
 

mbort

True Blue
Messages
2,338
Location
ENGLEWOOD/DENVER
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0
My experience with Medicare has been the same, they want them broken out by line item with the RT/LT and modifier 59. I did read this somewhere on the Medicare website some time ago but really do not have the time to go and research the website to post it.
 

missyah20

Guru
Messages
222
Location
Minneapolis
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0
OK so I called to Medicare(WPS) and I was told that I can quantity bill the 64472 code, but when you quantity bill you can not use a 50 modifier. I told her that these additional levels were done bilaterally. She said I could bill the 64472 with an RT,LT modifier on the same line with 2 units for the 2 additional levels. Does that seem right? Has anyone billed out a claim like this?

Is there any information out there on how MC wants this billed? All the information I have been able to find has led me to believe that we can bill the additional levels with a 50 and/or 50-59 modifier(s) on separate lines.
 

happycoder07

Networker
Messages
34
Location
Kansas City, MO
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0
missyah20

Hi,

When billing codes with the RT/LT modifiers should be done on 2 separate lines not 1 with 2 units, not correct coding.

Pedenia Y. Evans, CPC
 

missyah20

Guru
Messages
222
Location
Minneapolis
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0
That is what I thought! I was kind of confused when they told me I could bill them on the same line.

Thanks for all the info everyone!
 
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