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Cpt 64450

K

karras

Networker
Messages
61
Location
Coralville, IA
Has anyone been getting denials from Medicare regarding CPT code 64450? WPS has been denying this code regardless of the diagnosis for lack of medical necessity.

Thanks.
Kim
 
Look on your Medicare carrier's site for local coverage determination page. Look at the LCD titled such as Nerve Blocks for Peripheral Neuropathy. They are targeting blocks for peripheral neuropathy due to underlying systemic disease. But it causes 64450 to deny with codes like 719.46 or 729.2 or 719.47.

You would need to appeal stating that the condition was not due to underlying systemic diseases if that was the case. Our current carrier is revising and draft a new policy.
 
Nerve Block 64450

CPT 64450 is an NEC code - other peripheral nerve or branch.

I code a ton of labs with this type of scenario, so when I started coding anesthesia a year ago I was SOOOOO pro-active and knew I had better be adding a description to this procedure code. So whenever I use this code I actively make sure that the nerve they are administering the block to is in the procedure description.

It could be an LCD issue, but why not take the few moments it takes to just add the description to avoid the denial to begin with because they interpret it as a NEC code. Adding a description takes moments -vs- working a denial that takes away many moments.

Thanks,
Dana Chock CPC, CCA, CANPC, CHONC
Anesthesia, Pathology, & Laboratory Coder
 
I've looked at the diagnosis codes for several of those that were denied and they denied the claim regardless of the diagnosis. We've looked at the LCD and everyone seems to interpret it differently.

Dana, so you're adding a description every time you bill out this CPT code? Interesting idea.

Thanks for the suggestions!
Kim
 
More on CPT 64450

Yes, like for example 64450 I use for the TAP blocks, but depending on the application it may be more appropriate to use the 64425. I also use it on other nerves too. I found a great article you could refer to in September 2013 in AAPC Cutting Edge on Managing Postoperative Pain is a Joint Effort. You may find that helpful.
 
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