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Question Post Op Pain Management

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Margie Banta

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Irmo, SC
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How do you code the charge when a patient receives a PO pain block 64450 with ultrasound and an additional block that includes imaging like 64447
Example:
64450-59
76942-26
64447-59
The insurance companies are rejecting the 76942 as bundled even after appealing and sending documentation.

Thanks,
Margie Banta
 
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If it's denying 76942-26 as bundled, you may need to add modifier 59 or an X- modifier showing that it's a non-overlapping service. It could either be bundling into the blocks through the carrier's own edits or possibly against the primary surgery code. I couldn't check that since you didn't mention it but it's something to look at as well.

Hope this helps!
Kellie
 
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64450 does not have U/S bundled, so 76942-26 should not be denied if it's only billed with one unit. However, you need to add laterality modifiers to the block codes.

I also suggest checking the payor's policy to see if they require XU instead of 59.
 
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In case you need a reference; NCCI Manual:

15. If the code descriptor for a HCPCS/CPT code, CPT Professional codebook instruction for a code, or CMS instruction for a code indicates that the procedure includes radiologic guidance, a provider/supplier shall not separately report a HCPCS/CPT code for radiologic guidance including, but not limited to, fluoroscopy, ultrasound, computed tomography, or magnetic resonance imaging codes. If the physician performs an additional procedure on the same date of service for which a radiologic guidance or imaging code may be separately reported, the radiologic guidance or imaging code appropriate for that additional procedure may be reported separately with an NCCI PTP associated modifier if appropriate.

As suggested above, the health plan may have different policies on it.
If it was in the same anatomic area, they may not pay it no matter what modifier.

Why do you have a 59 on both 64450 & 64447? What are you unbundling it from?
 
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