Question SIJ/Medial Cluneal Nerve Stimulator Coding

snoopydoo

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Albany, Oregon
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My pain management provider coded this procedure with 64555-51 (2 units), 64575, 64590 (2 units). Medicare denied the last 2 codes. Are the codes included in the primary? DX code is G58.9. Can anyone clarify this? Thanks in advance!
 

dnostdahl

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What did your provider do? 64555 x 2 units and 64590 are billable together as there is no CCI Edit. 64575 has an edit which exists with 64555 as 64575 is a column 2 code, so if 64555 & 64575 are bill together only 64555 will be paid. 64555 is also a primary code so a 51 modifier would not be necessary for a primary code.
G58.9 - Mononeuropathy, unspecified is a covered diagnosis code according to the LCD for CMS.
 
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