celcano
Networker
Hi, all! I am really confused now and need some expert assistance. I have been in Pain Management billing for 4 years. I was always taught that when we did an L5-S3 nerve block that we billed 4 units of 64450. My physician, who attends coding classes with us, feels the correct way to code this is 64450 X 4. We have been fighting with our state Medicaid as they only want to pay for 3 units. I have just received an "Edit Clarification" for 64450 from them. I have attached their response (scroll to attachment below).
To add the confusion, I found this from AH"IMA from 05/29/2015:
"QUESTION 3
A patient was seen at our facility and underwent a left-sided L5 and S1, S2, S3, and S4 lateral branch nerve block for diagnostic purpose with C-arm fluoroscopy. What are the correct codes for a lateral nerve block?
ANSWER
Based on the operative report a medial branch nerve block was performed at the L5 and a lateral branch nerve block was performed at the S1, S2, S3 and S4.
Therefore, it would be appropriate to report CPT code 64493, Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapohphyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral, single level, for the L5 medial branch block.
For the 4 lateral branch block injections at S1, S2, S3, and S4, report 4 units of CPT code 64450, Injection, anesthetic agent; other peripheral nerve or branch."
It has been my understanding that we can't bill a 64493 because we are not blocking a joint. Are we incorrectly coding a L5-S3 nerve block with 64450 X 4? If not, then how do I fight this. I can't find anything that definitively states this other than ablations of L5-S3 nerves are coded with 64640 X 4. We submitting that to them and, again, they came back with the attachment below.
Any assistance will be GREATLY appreciated.
ADDED ATTACHMENT INFORMATION - MEDICAID EDIT CLARIFICATION
"Procedure 64450 is used to report the introduction/injection of an anesthetic agent into a peripheral nerve or branch. A peripheral nerve refers to any motor and/or sensory nerves and ganglia that exists outside the brain or spinal cord that is not specifically listed elsewhere in CPT.
The Global Duplicate Value is the total number of times per date of service that a given procedure may be appropriately submitted. This is reflective of the total number of times it is clinically possible or clinically reasonable to perform a given procedure on a single date of service across all anatomic sites. After the maximum number of times is reached, additional submissions of the procedure are not recommended for reimbursement. Duplicate values are assessed for accuracy based on the number of submissions of a specific procedure according to anatomic sites and CPT/CMS guidelines.
Procedure 64450 is typically used for dorsal branch paravertebral nerve injections undertaken at several levels. An example is facet nerve injections which can done multiple levels and would encompass 3 branches, unilaterally or bilaterally (6 total)."
To add the confusion, I found this from AH"IMA from 05/29/2015:
"QUESTION 3
A patient was seen at our facility and underwent a left-sided L5 and S1, S2, S3, and S4 lateral branch nerve block for diagnostic purpose with C-arm fluoroscopy. What are the correct codes for a lateral nerve block?
ANSWER
Based on the operative report a medial branch nerve block was performed at the L5 and a lateral branch nerve block was performed at the S1, S2, S3 and S4.
Therefore, it would be appropriate to report CPT code 64493, Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapohphyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral, single level, for the L5 medial branch block.
For the 4 lateral branch block injections at S1, S2, S3, and S4, report 4 units of CPT code 64450, Injection, anesthetic agent; other peripheral nerve or branch."
It has been my understanding that we can't bill a 64493 because we are not blocking a joint. Are we incorrectly coding a L5-S3 nerve block with 64450 X 4? If not, then how do I fight this. I can't find anything that definitively states this other than ablations of L5-S3 nerves are coded with 64640 X 4. We submitting that to them and, again, they came back with the attachment below.
Any assistance will be GREATLY appreciated.
ADDED ATTACHMENT INFORMATION - MEDICAID EDIT CLARIFICATION
"Procedure 64450 is used to report the introduction/injection of an anesthetic agent into a peripheral nerve or branch. A peripheral nerve refers to any motor and/or sensory nerves and ganglia that exists outside the brain or spinal cord that is not specifically listed elsewhere in CPT.
The Global Duplicate Value is the total number of times per date of service that a given procedure may be appropriately submitted. This is reflective of the total number of times it is clinically possible or clinically reasonable to perform a given procedure on a single date of service across all anatomic sites. After the maximum number of times is reached, additional submissions of the procedure are not recommended for reimbursement. Duplicate values are assessed for accuracy based on the number of submissions of a specific procedure according to anatomic sites and CPT/CMS guidelines.
Procedure 64450 is typically used for dorsal branch paravertebral nerve injections undertaken at several levels. An example is facet nerve injections which can done multiple levels and would encompass 3 branches, unilaterally or bilaterally (6 total)."
Attachments
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