Wiki Pain Management Billing

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sslagle

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We are billing for a bilateral lumbar RFA for 3 levels and are having trouble getting the add on code to pay. It is 64635 Mod 50 and then since the add on code can no longer be coded with a mod 50 we have done 64636 with 4 separate line items (with no modifier) and it has denied. The 2021 CPT book states "for bilateral procedure, report 64636 twice. Do not report modifier 50 in conjunction with 64636." I can't seem to figure out the way it needs to be coded.
Some options we've come up with are:

64635-50
64636-RT 2 units (double charge amount)
64636-LT 2 units (double charge amount)

64635-50
64636-RT (one unit)
64636-LT (one unit)
64636-RT (one unit)
64636-LT (one unit)


We have also had trouble coding facet injections. This procedure was for bilateral lumbar facets for 3 levels. 64494 and 64495 were coded as one unit with no modifiers as follows:

64493-Mod 50
64494
64494
64495
64495

The claim paid 64493-mod 50, one line item of 64494 and one line item of 64495. They denied one of each of the 64494 and 64495 line items as duplicates.


Any insight on coding with the new bilateral guidelines would be very much appreciated!
 
Having same dilemma, with research I discovered that some insurance companies adopted the 2020 change and some haven't. We actually tried to rebill and put just modifier 50 on both, the old way. Because some of my claims have paid that way. I know it doesn't make sense, why some pay and some don't. My issue is with Medicare. We have tried it with the 64635-50, 64636-RT, 64636-RT and I don't think it got paid either. I have tried to add modifier XS too. We are trying different techniques to see what they will pay. I do know some +add on codes can only be submitted once not multiple times. I read in our guidelines on some. I'm not by my book so I can't give any insight into which ones. I'm hoping they find a fix for spinal injections and pain management soon. Lol it is a pain indeed.
Here is what I tried last but only using 1 unit for the rt and lt. It shouldn't be 2 units, that would reflect they are doing twice the amount that side/level.
64635-50
64636-RT
64636-LT
I agree any insight would be helpful. Thanks.
 
Going thru the same thing over here... I agree with you, i don't think all payers are adopting the new rules.
However the CPT book (2021) also contradicts at some level for codes 64492/64495. It specifically says to bill add on codes twice when preformed bilaterally, but then it has a note for add on codes 64492/64495 where they cannot be billed more than once per day? so can we bill them twice or not when done bilaterally... its very confusing and nothing is getting paid for these add ons. Its frustrating.
If anyone has billed these on 2021 and gotten them paid please share your tactics... !!!!
 
I know they changed the way you're supposed to bill them but I didn't have success either so I've continued doing the old way and everything is still being paid - EXCEPT the 2 units of bilateral RFA add-on code (never been paid). So I've told the doctors to only do RFA on one side at a time (which is what they normally do here anyway).

I'll be watching for if someone figures out how to get the new billing guidelines paid! Thanks for asking this question!
 
IS MEDICARE PAYING FOR 64493, 64494, 64495 DX M48.062; BILLING FOR ASC AND I DO HAVE ABN FORM SIGNED; HOWEVER I HAVE NOTICED THEY WILL ONLY PAY ONE LINE FOR ASC, IS THIS CORRECT?
 
weimobsessed said:
IS MEDICARE PAYING FOR 64493, 64494, 64495 DX M48.062; BILLING FOR ASC AND I DO HAVE ABN FORM SIGNED; HOWEVER I HAVE NOTICED THEY WILL ONLY PAY ONE LINE FOR ASC, IS THIS CORRECT?
Click to expand...
I don't bill for ASC but M48.062 does not support medical necessity for 64493/4/5 so if they're not paying, that could be why
 
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