Wiki Radiofrequency Need Your Expertise


Pittsboro, NC
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Our physician has been performing CPT 64635 and 64636, destruction by neurolytic agent, paravertebral facet joint nerve(s) on the right side and then three weeks later treating the left side. Since we can bill for radiofrequencies twice per year, she repeats this process a second time so that the patient has a total of four treatments. I'm not sure why she's not doing the procedure bilaterally but can she continue performing and billing this procedure like this? I hope this makes sense. Any help I can get will be much appreciated!
My providers typically performed injections at both sides when there was a need for50

If the procedure is only payable twice a year, I think you’re going to end up with a situation where you get paid for the first two, but have to adjust off the other two, or charge to the patient. It sounds a little weird that your provider would bring them back at separate dates to do each side (especially if this is an across the board policy), unless there is documented reason. Unless you find something from the AMA or some other professional board, stating a justification/ benefit to the patient for performing the procedure in this fashion.
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Depending on the payer (we have a medicaid payer that won't accept any modifiers whatsoever), you should be able to add LT and RT modifiers and not have any trouble getting paid as long as she's doing them at separate encounters. If she does them bilaterally in the same session you have to bill with 50 mod.

Having said that, it is kind of unusual, though I have seen providers do it that way before. Has she mentioned her reasoning?
I know we can report modifiers LT, RT or 50, but my concern is that we can only perform this procedure twice per year bilaterally. Our physician is doing the procedures on four separate visits but only doing one side at each visit. Does that make sense. I'm not sure what her reasoning is for doing this but I'm wondering if we can even bill it that way. I appreciate your responses. It's helping a lot!
For clarification…

So the carrier will only pay the procedure if done bilaterally twice a year? How many times a year will they pay it unilaterally? If they are willing to pay it more times unilaterally, then this makes since as to why she is doing this; however I would make sure she is clearly documenting why she is doing this. (I'm sorry I know what I'm trying to say, I'm just not explaining it well).
My thought was that filling them with the LT and RT mods would show that they aren't bilateral. The patient is still only receiving 2 treatments per side, per year, right? I am not aware of any nationwide regulations that state you can't treat one side at a visit and then the opposite side at another visit. If it's a specific payer thing then you may be able to get some guidance from them. Sorry, again, not much help here.
It might be that the physician feels this is the safest for the patient that they only perform the procedure only on one side at a time.

There will be an increase cost for the carrier/ the patient and it is important it is established there is a clinically relevant reason by having separate encounters.