Botox for migraine and lumbar facet medial nerve block

twhisnant

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Owensboro, KY
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I code for a pain management specialist. He recently performed a lumbar facet nerve block on the bilateral L3-L4, L4-L5 and L5-S1 levels. On the same day he injected botox into the bilateral frontal, temporal and glabellar regions, upper, middle and lower trapezius and splenius capitis paraspoinal regions for migraines. Super Coder states 64493 bundles with 64615 as misuse of column two code with column one and 64495 and 64494 cannot be billed together in any circumstances with 64615. Before I send this back to the doctor, I wondered if any one would have an idea on why this is the case? I could see where a cervical nerve block would bundle with botox for migraines since it includes the cervical spinal and accesory nerves but am perplexed by the lumbar nerves. Any suggestions on where I can find information to give to my doctor? Thanks!!

Tammy, CPC
 
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Scotia, NY
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Perhaps it is just that 64494 and 64495 are add on codes and the 64493 would be the qualifying procedure. I would think that with the correct modifier it should be able to be billed together since it is a separate anatomical location.

I am not sure if calling the insurance would get you anywhere but maybe worth a try??

Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management
 

thomas7331

True Blue
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I noticed this as well in the April 2017 updates to the NCCI edits. I have not been able to locate any documentation saying why the code pair was added and why it can't be overridden with a modifier. It may be an error in the NCCI revision. If so, and if this is Medicare, you may have to take it to at least a second or third level appeal in order to get a resolution.
 

TLafleur67

Contributor
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It's part of NCC edits with a modifier indicator of 0, i.e., can't be overridden
I don't know if you can blow up the image below, but here it is

NCC072017.png
 
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