Wiki Pain Injections and Modifier 76-Medicare

Soms4

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Hello,

Has anyone had issues with Medicare paying for all lines on for example 64450, 64450 59, 64450 59? We have some Medicares that are only paying the first line. We have appealed stating we have not met MUE and sent in information for medical necessity. One Medicare Rep stated to use the 76 modifier. However I don't think that would be appropriate. Has anyone else had experience with this? Have you used the 76 modifier? We are an ASC.

Thanks
 
76 would be incorrect. 76 is for the same procedure performed in a different session. Have you tried using the XS modifier to indicate separate site? what specific nerves is your provider injecting?
 
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I agree, I don't agree with the 76 modifier but thought it was odd a Medicare Rep recommended that. Maybe a better example of where also we are seeing this is when they do a rhizotomy at several sacral levels for 64640.

Per the AMA:
When performing individually separate nerve destruction, each peripheral nerve root neurolytic block is reported as destruction of a peripheral nerve, using code 64640, Destruction by neurolytic agent; other peripheral nerve or branch. In this instance, for peripheral nerve root neurolytic blocks (destruction) of L5, S1, S2, and S3, code 64640 should be reported four times. The coder should append modifier 59, Distinct Procedural Service, to the second and subsequent listings of code 64640 to separately identify these procedures.

We have not tried the XS only the 59.
 
The 59 is a CPT modifier and the XS is a CMS modifier. I have noticed this year more and more Medicare is not accepting of the 59 when an X modifier is more descriptive. I would try the XS before anything more drastic. please keep us informed!
 
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