Wiki RE: bundling with CPT codes 20610 and 64418

[ollielooya]

RE: bundling with CPT codes 20610 and 64418

Hi specialists, and although I've had only one response from submitting a more detailed question to the general forum, thought I'd try this forum and rheumatology to see if there are any that know the answer. I know AAPC frowns on cross-coding posts, but really need some input.Without supplying chart notes just want some general input for my studies.

If these 2 codes (20610 and 64418) are billed together, NCCI edits indicate a bundling relationship--a modifier can over-ride (if appropriate) & would apply to 64418. However both 20610 & 64418 were performed in the same area (shoulder), so which modifier might be appropriate, 59 or XU? Dr. does not usually perform these 2 procedures together as 64418 suprascapular block is for pain control and for this particular patients case, each code has it's own separate dx code. Therefore, what reason might these 2 procedures be unbundled when performed in same area & what modifier would be a better choice? Still trying to determine if XU might be a valid choice.

I'm just trying to ascertain from a general perspective as I do not yet have the notes if there ARE cases where procedures performed in the same area with different dxs might qualify for bypassing the edits...

 

[mray85]

Suzanne,
This is from the NCCI manual for 6 series codes.
"Medicare Global Surgery Rules prevent separate payment for postoperative pain management when provided by the physician performing an operative procedure. CPT codes 36000, 36410, 37202, 62310-62319, 64400-64484, and 96360-96376 describe some services that may be utilized for postoperative pain management. The services described by these codes may be reported by the physician performing the operative procedure only if provided for purposes unrelated to the postoperative pain management, the operative procedure, or anesthesia for the procedure."

If 20610 is to inject a medication, such as a steroid, and then he injects a nerve block for the pain from the same joint, only report 20610.

Hope this helps!