Medicare and 3rd level facet blocks

[kimmcelderry@gmail.com]

Hi there, recently Medicare made it policy to deny 3rd level blocks. The LCD states they can be appealed upon denial, but I'm not sure when/why a 3rd level block would be medically necessary? What are grounds for appeal? Thanks for any help.

 

[jrclark1987@yahoo.com]

https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=57826&Cntrctr=297&ContrVer=1&CntrctrSelected=297*1&DocType=Active

Medicare is still establishing a list of coverage DX. I use the covered DX dictated for that level and appeal with the procedure note when denied.

 

[kimmcelderry@gmail.com]

https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=57826&Cntrctr=297&ContrVer=1&CntrctrSelected=297*1&DocType=Active

Medicare is still establishing a list of coverage DX. I use the covered DX dictated for that level and appeal with the procedure note when denied.

Are you getting them paid? I have the same M47.816 dx on all three levels.

 

[jrclark1987@yahoo.com]

Are you getting them paid? I have the same M47.816 dx on all three levels.

yes i have been successful with sending in the notes. if done at the L5-S1 level I make sure and distinguish that 3rd level with lumbosacral DX codes M47.817 VS M47.816. hope this helps

 

[kimmcelderry@gmail.com]

Ok I'll try it! Thanks!

 

[Jvdav12]

yes i have been successful with sending in the notes. if done at the L5-S1 level I make sure and distinguish that 3rd level with lumbosacral DX codes M47.817 VS M47.816. hope this helps

Yay, we have not had a response yet when sending in the 3rd level appeal to Medicare. Are you sending just the op note and ensuring the dx or are you also sending supporting documentation or medical necessity for the 3rd level?

 

[jrclark1987@yahoo.com]

Yay, we have not had a response yet when sending in the 3rd level appeal to Medicare. Are you sending just the op note and ensuring the dx or are you also sending supporting documentation or medical necessity for the 3rd level?

Yes. I have taught my Provider very well to document CPT verbiage. He will Document 3rd additional level performed for lumbosacral spondylosis at L5-S1. I have been successful