Wiki Reporting units for 64493-94494

[plex932]

Would like to know the correct way to report units for above codes, both codes are bitlateral-L4-L5 L5-S1 done, fluoroscopy used, billing to pip carrier.
64493-50@2units
64494-50@2units
72275-included in ASC facility fee
77003-included in ASC facility fee
claim denial for number of units is invalid.????
any suggestions.
Thank you

 

[aaron.lucas]

Yes the units are invalid, for a couple reasons.

1. 64493 and 64494 are only for the first and second levels, respectively, and you can only have one first and one second level, right? Kind of like "you only get one chance to make a first impression" (wasn't that the head & shoulders slogan?). Any additional levels would need 64495.

2. You're using modifier -50, which means both sides are being done, so that already means "two injections". Using 2 units as well is basically saying "4 injections", or two on each side.

As an added note, fluoro is included in facet injections per CPT regardless of who is billing. And if you do bill 64495, you can only bill one unit of that as well, as it states "third and any additional levels", so you can really only bill one unit each of all three codes for each region set. Out of curiosity, are you in NJ? Because NJ PIP states that all diagnostic procedures are included in the ASC fee, which is matching what you said there. I ask because the NJ Fee Schedule rule text states bilateral surgeries shall be reported with modifier -50 as a single line item. Hope this all helps!