Wiki CPT 64447 Denying for unit or basis of measure

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wonder1963

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Medicare is denying 64447 for unit of measure . I billed per unit with a 59 modifier . can someone tell me how I should bill this?
 
Denial

CodingKing said:
MUE is 1 per day. If its bilateral use mod 50 w/ 1 unit
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I did bill for one unit and it is not bilateral this is the rejection i get from medicare



Line: 1 64447 $337.00
Service line rejected
Service line Status: A7 - Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected.
Service line Detail: 732 - Information submitted inconsistent with billing guidelines. Note: At least one other status code is required to identify the inconsistent information.
Action Taken: Action Code: U - Rejected
Additional Status -----
Service line rejected
Service line Status: A7 - Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected.
Service line Detail: 659 - Unit or Basis for Measurement Code
 
If the block was NOT the primary anesthesia method, we bill 64447 with a 59 at one unit with the dollar amount equal to 7 units. Per the Relative Value Guide, 64447 is 7 units. If the MD used US, we also bill out 76942 with a 26 with dollar amount equal to 2 units.

We found that insurance companies are paying when we bill it out this way.
 
wonder1963 said:
Medicare is denying 64447 for unit of measure . I billed per unit with a 59 modifier . can someone tell me how I should bill this?
Click to expand...
I understand this is a very old thread however, I am finding the same issue. Primary anesthesia code is 01992-QZ-QS-P2 (moderate sedation, CRNA) billed as Minutes, post-op pain block 64447-59 billed as 1 Unit denying by Medicare via clearinghouse for same reason as above (Acknowledgement/Rejected for Invalid Information-The claim/encounter has invalid information as specified in the Status details and has been rejected : Information submitted inconsistent with billing guidelines... Acknowledgement/Rejected for Invalid Information-The claim/encounter has invalid information as specified in the Status details and has been rejected : Unit or Basis for Measurement Code)."

Does anyone have any suggestions? Does this need to be billed as Minutes for some reason? I have researched everywhere I know and can still not figure out what the issue is however, I am new to anesthesia billing. Thank you.
 
k8mbee said:
I understand this is a very old thread however, I am finding the same issue. Primary anesthesia code is 01992-QZ-QS-P2 (moderate sedation, CRNA) billed as Minutes, post-op pain block 64447-59 billed as 1 Unit denying by Medicare via clearinghouse for same reason as above (Acknowledgement/Rejected for Invalid Information-The claim/encounter has invalid information as specified in the Status details and has been rejected : Information submitted inconsistent with billing guidelines... Acknowledgement/Rejected for Invalid Information-The claim/encounter has invalid information as specified in the Status details and has been rejected : Unit or Basis for Measurement Code)."

Does anyone have any suggestions? Does this need to be billed as Minutes for some reason? I have researched everywhere I know and can still not figure out what the issue is however, I am new to anesthesia billing. Thank you
Click to expand...
If moderate sedation or MAC are the anesthesia method, the anesthesia method on the claim should be Regional. Blocks may not be billed separately for these anesthesia methods.

You may only bill blocks separately when the Spinal or General are the anesthesia methods.
 
LisaAlonso23 said:
If moderate sedation or MAC are the anesthesia method, the anesthesia method on the claim should be Regional. Blocks may not be billed separately for these anesthesia methods.

You may only bill blocks separately when the Spinal or General are the anesthesia methods.
Click to expand...
Do you happen to have experience with code 64483 being billed by facility and administering doc (pain management) and CRNA billing 01992 with QZ modifier? Three separate claims. CRNA is only monitoring vitals with no anesthetic given. Max of 10 min. The CRNA does do a pre-op consult. I would think that CRNA isn't able to bill 01992 because only vitals are being monitored?
 
lklokner said:
Do you happen to have experience with code 64483 being billed by facility and administering doc (pain management) and CRNA billing 01992 with QZ modifier? Three separate claims. CRNA is only monitoring vitals with no anesthetic given. Max of 10 min. The CRNA does do a pre-op consult. I would think that CRNA isn't able to bill 01992 because only vitals are being monitored?
Click to expand...
64483 should have an ASA code of 01937 (cervical or thoracic) or 01937 (lumbar or sacral) depending on the area of the spine targeted.

What you're describing is actually MAC. The CRNA is there the entire time monitoring the patient in the event General needs to be administered.

Correct coding: 66843/01937 or 01937-QS-QS
 
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