Wiki Pain Management New codes

[jschoening]

Hello,

I have a couple questions regarding the pain management billing changes coming this year, just looking for some feedback.

Re: Sacroiliac Joint RFA. We would usually bill 64635 for L5, 64640 for S1-S3. I am assuming I would bill 64635, then 64625x1?

Re: Sacroiliac Joint Injections. Would we bill 27096, or 64451?

Re: Genicular Nerve Ablations. Would we bill one unit of 64624 for one side?

Any help would be appreciated. Thank you!

 

[jkyles]

EDIT

Hi, I'm doing some research on this question but for starters it is really important to look at the carrier's policies. CCI v26.0 does not follow the guidance in the CPT manual. If you're billing Medicare or any private payer that uses the CCI edits it is going to be different. (I got confused here, CCI doesn't follow CPT for the blocks, but it does for the RFAs.)

But assuming a payer that follows CPT:

1. You can't report 64625 in conjunction with 64635.
2. An injection of the joint is still reported with 27096. Injections of the nerves innervating the SI joint would be reported with 64451.
3. Yes.

The other thing to check for private payers: Does the private payer cover the new codes at all? I've seen at least one policy that lists the genicular blocks as experimental.

 

[jschoening]

EDIT

Hi, I'm doing some research on this question but for starters it is really important to look at the carrier's policies. CCI v26.0 does not follow the guidance in the CPT manual. If you're billing Medicare or any private payer that uses the CCI edits it is going to be different. (I got confused here, CCI doesn't follow CPT for the blocks, but it does for the RFAs.)

But assuming a payer that follows CPT:

1. You can't report 64625 in conjunction with 64635.
2. An injection of the joint is still reported with 27096. Injections of the nerves innervating the SI joint would be reported with 64451.
3. Yes.

The other thing to check for private payers: Does the private payer cover the new codes at all? I've seen at least one policy that lists the genicular blocks as experimental.

Thank you for the information. Much appreciated.