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multi level facet injection question

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5
Best answers
0
Hello everyone, I need help billing Facet injections. Here is the senario - the Dr. injected at levels C6, C7, T1, T2 then lumbar levels L1, L2. I have had a hard time getting reimbursed by different carriers. I have 2 ways that I have been told to bill, if anyone can provide additional info please share or indicate which senario you would go with:

senario #1
64470
64472 x2 units
or
senario #2
64470
64472
64475(59 mod)
 

dmaec

True Blue
Messages
1,130
Location
Hibbing, Minnesota
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0
the way I read the scenario - 3 different levels - T/C/L - when my provider does these he marks (and I agree)
64475
64470
64472
no need for modifier .59 (as 64475 is a different level than 64470 and 64472 is an add on code) per CCI guidelines also ;)
Also, linking the dx's to cpt's very important because of the 3 different levels.
we haven't had any payment issues on this to my knowledge.
{that's my opinion on the posted matter}
 
Last edited:
Messages
9
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0
i would use your scenerio #2 I was taught to use mod 59 to show the levels the physician has entered. I, myself use mod and the second procedure all the way down.
 
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