ms.bones206
Networker
My physiatrist performed a BIL RFA for 3 levels...all requirement are met and documentation is there. Charges got denied, I did research and this is what I found.
LCA A58777
L38841
Frequency: One to two levels, either unilateral or bilateral, are allowed per session per spine region. The need for a three or four-level procedure bilaterally may be considered under unique circumstances and with sufficient documentation of medical necessity on appeal. A session is a time period, which includes all procedures (i.e., medical branch blocks (MBB), intraarticular injections (IA), facet cyst ruptures, and RFA ablations) that are performed during the same day.
4/18/19 - CESI
2/13/20 - BIL 3 LEVEL FACET
3/03/20 - BIL 3 LEVEL FACET
3/17/20 - BIL 3 LEVEL RFA
1st QUESTION: Based on frequency above did I go over the limit?
2nd QUESTION: Has anyone gotten a 3rd level RFA approved and if so, what documentation is required or did you use to provide unique circumstances with sufficient documentation of medical necessity on appeal?.
LCA A58777
L38841
Frequency: One to two levels, either unilateral or bilateral, are allowed per session per spine region. The need for a three or four-level procedure bilaterally may be considered under unique circumstances and with sufficient documentation of medical necessity on appeal. A session is a time period, which includes all procedures (i.e., medical branch blocks (MBB), intraarticular injections (IA), facet cyst ruptures, and RFA ablations) that are performed during the same day.
4/18/19 - CESI
2/13/20 - BIL 3 LEVEL FACET
3/03/20 - BIL 3 LEVEL FACET
3/17/20 - BIL 3 LEVEL RFA
1st QUESTION: Based on frequency above did I go over the limit?
2nd QUESTION: Has anyone gotten a 3rd level RFA approved and if so, what documentation is required or did you use to provide unique circumstances with sufficient documentation of medical necessity on appeal?.