CPT codes 64475 and 64476

jenniferg

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If anyone has experience on coding for CPT codes 64475 and 64476, I will appreciate your help.

When billing Medicare, I have a Pain Management provider who does MULTIPLE BILATERAL injections utilizing CPT codes 64475 and 64476. In the past, I used to bill these with a RT and LT modifier along with modifier -76 when multiple injections are done. Medicare has denied stating that the -76 modifier is not applicable for these CPT codes. I have also used strictly the 50 modifier (billing all on one line item for Medicare) for bilateral along with unit values based on how many injections the provider had done on each side, bilaterally. This scenario has also been denied, stating that I am unable to bill multiple units for 64476.

Has anyone encountered this before? Does anyone have experience on how to appropriate bill for CPT codes 64475 and 64476?

Thanks in advance.

Jennifer Gauger, CPC
Coding Department Supervisor
ebix, inc.
jenniferg@ebixinc.com
 

donnajrichmond

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Does your carrier have an LCD for facet joint injections? That would be the place to start.
Otherwise, these should be coded with -50 for bilateral injections.
If your carrier is denying with frequency, they may want -59 for the additional levels.
By CPT if 3 levels were injected, for instance L1-L2; L2-L3; L3-L4 bilaterally, you would code 64475-50, 64476-50 x 3.
You could try 64475-50, 64476-50, 64476-50-59, 64476-50-59, but I'd check the LCD first to see how they want them.
77003 would only be coded once
 

jenniferg

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Thanks for the assistance. I did call our Medicare carrier and they do not have a policy for these codes. I did not try using the -59 modifier, only billing with the -50 modifier X3. This is what they denied as not being able to bill these codes with multi-units.

Thanks for the suggestion of -59. I will try it.

Jennifer Gauger, CPC
 

HCCCoder

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I was just researching about CPT codes 64475 and 64476 and I found out this thread.
I thought, we can't bill an add-on code with any modifier. Can someone please explain this situation, how come the add on code 64476 can be billed with modifier 50?

Thank you,
Lilit
 

magnolia1

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You cannot use modifier "51" with add-on codes.
You can use modifiers that identify the laterality of the procedure(s).

Also, due to the description of 64476 (each add'l level), modifier "59" is not required in these cases.
 

HCCCoder

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I have "Bilateral S1 neuroforaminal/sleeve root blocks" and the doctor billed for 64483, 64484-59, is this correct? If not, how is this supposed to be coded?
Thank you,
Lilit
 

HCCCoder

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Karen, might you also know how to code the following?
Radiofrequency rhizotomy of the right lumbar medial branch nerves at L2, L3, L4, L5, S1, needle localization?

Thanks in advance,
Lilit
 

CoderinJax

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Help!! OP report attached!

Procedure performed:
Lumbar radiofrequency denervation L2-L3, L3-L4,
L4-L5, and L5-S] bilateral, sacroiliac joint
radiofrequency denervation x4 bilateral.


DESCRIPTION OF PROCEDURE:
The patient was identified as Bob the Builder and was brought to the operating suite. After placing appropriate monitoring devices and intravenous lines, monitored anesthesia care was induced. The patient was placed in prone position on the operating table. Care was taken to make sure all bony prominences had gentle pressure. Care was taken to make sure the brachial plexus had normal pressure. The neck was carefully flexed in all planes. The patient was then prepped and draped in the usual sterile manner in the lumbar field. Under fluorometric guidance, the L1-L2 facet joint was localized and injected with 0.5 cc of 0.5% Marcaine and then heated to 80”C for 90 seconds. This was done at L2-L3, L3-L,4, L4-L5, and L5-Sl first on the right and left and then was done at the sacroiliac joint in four locations first on the right and then on the left.

Physician wants to bill 64475 x 1 and 64476 x 19. (I KNOW this is SO wrong, but I'm confused between the 64475 and the 64622 code ranges.)

Can anyone help me please?? Thanks SO much!
 

RebeccaWoodward*

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Procedure performed:
Lumbar radiofrequency denervation L2-L3, L3-L4,
L4-L5, and L5-S] bilateral, sacroiliac joint
radiofrequency denervation x4 bilateral.


DESCRIPTION OF PROCEDURE:
The patient was identified as Bob the Builder and was brought to the operating suite. After placing appropriate monitoring devices and intravenous lines, monitored anesthesia care was induced. The patient was placed in prone position on the operating table. Care was taken to make sure all bony prominences had gentle pressure. Care was taken to make sure the brachial plexus had normal pressure. The neck was carefully flexed in all planes. The patient was then prepped and draped in the usual sterile manner in the lumbar field. Under fluorometric guidance, the L1-L2 facet joint was localized and injected with 0.5 cc of 0.5% Marcaine and then heated to 80”C for 90 seconds. This was done at L2-L3, L3-L,4, L4-L5, and L5-Sl first on the right and left and then was done at the sacroiliac joint in four locations first on the right and then on the left.

Physician wants to bill 64475 x 1 and 64476 x 19. (I KNOW this is SO wrong, but I'm confused between the 64475 and the 64622 code ranges.)

Can anyone help me please?? Thanks SO much!
Since the op note states denervation, you would count the actual number of nerves. In this case, you would report:

64622-50 (L2)
64623-50 x 4 (L3, L4, L5, S1)

5 Nerves

Count the number of nerves he/she injects, not the individual injections.

Had this been a nerve block, you have would counted the levels

In that case, you would have had:

64475-50 (L2-L3)
64476-50 x 3 (L3-L4 L4-L5 L5-S1)

4 levels
 
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