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64450/medicare

  1. #1
    Location
    upper saddle river,nj
    Posts
    113
    Default 64450/medicare
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    Does anyone seem to have an idea on how to get reimbursement from medicare regarding cpt 64450? Any dx code that i use is being denied as not medically necessary/non covered service. It seems that medicare sees this code as an nec, would anyone have any suggestions on an alternate code or what could be the best way to get 64450 processed?

    Thanks

  2. #2
    Default
    There are a number of states/Medicare jurisdictions that have an LCD for 64450. I imagine you are in one of them.

    You need to check the LCD.

    I could help if I knew what state you are in and what diagnosis you are using.
    Kelly A Mcfadyen, CPC

  3. #3
    Default
    You need to pull the local coverage determination policy that could potentially be titled Local Coverage Determination (LCD):
    Nerve Blocks for Peripheral Neuropathy (L34673)

    If it is similar to the below LCD from WPS Medicare J5 you will see at the bottom of the policy it states

    Peripheral nerve injections will not be allowed unless medical records are reviewed and the services are approved during the redetermination process.

    So you have write an appeal and it has demonstrate that the nerve block was not for "the treatment of multiple neuropathies or peripheral neuropathies caused by underlying systemic diseases" and provide the medical records. They will review it paid it if is not due to "underlying systemic diseases"

    Coverage Indications, Limitations, and/or Medical Necessity

    Nerve blocks cause the temporary interruption of conduction of impulses in peripheral nerves or nerve trunks by the injection of local anesthetic solutions.

    The use of nerve blocks or injections for the treatment of multiple neuropathies or peripheral neuropathies caused by underlying systemic diseases is not considered medically necessary. Medical management using systemic medications is clinically indicated for the treatment of these conditions.

    Limitations

    The use of nerve blocks with or without the use of electrostimulation, and the use of electrostimulation alone for the treatment of multiple neuropathies or peripheral neuropathies caused by underlying systemic diseases is not considered medically reasonable and necessary.

    At present, the literature and scientific evidence supporting the use of peripheral nerve blocks with or without the use of electrostimulation/electromagnetic stimulation, and the use of electrostimulation/ electromagnetic stimulation alone for neuropathies or peripheral neuropathies caused by underlying systemic diseases, is insufficient to warrant coverage. These procedures are considered investigational and are not eligible for coverage for the treatment of neuropathies or peripheral neuropathies caused by underlying systemic diseases.

    The use of ultrasound guidance in conjunction with these non -covered injections is also considered not medically necessary and will result in denial.

    Subcutaneous injections do not involve the structures described by CPT code 64450, direct injection into other peripheral nerves, but rather the injection of tissue surrounding a specific focus. These therapies are not to be coded using CPT code 64450. This code addresses the additional work of an injection of an anesthetic agent (nerve block), into relatively more difficult peripheral nerves, rather than that involved in an injection of relatively easily localized areas.




    Back to Top
    Expand/collapse the Coding Information section Coding Information Bill Type Codes:
    Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

    N/A

    Revenue Codes:
    Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.


    N/A

    CPT/HCPCS Codes
    Group 1 Paragraph: N/A

    Group 1 Codes:
    64450 INJECTION, ANESTHETIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH

    Group 2 Paragraph: Note: Use of the following CPT/HCPCS Codes for these treatments is inappropriate and will be denied:

    Group 2 Codes:
    76881 ULTRASOUND, EXTREMITY, NONVASCULAR, REAL-TIME WITH IMAGE DOCUMENTATION; COMPLETE
    76882 ULTRASOUND, EXTREMITY, NONVASCULAR, REAL-TIME WITH IMAGE DOCUMENTATION; LIMITED, ANATOMIC SPECIFIC
    76942 ULTRASONIC GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION, LOCALIZATION DEVICE), IMAGING SUPERVISION AND INTERPRETATION
    76999 UNLISTED ULTRASOUND PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL)
    97032 APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ELECTRICAL STIMULATION (MANUAL), EACH 15 MINUTES
    97139 UNLISTED THERAPEUTIC PROCEDURE (SPECIFY)
    G0282 ELECTRICAL STIMULATION, (UNATTENDED), TO ONE OR MORE AREAS, FOR WOUND CARE OTHER THAN DESCRIBED IN G0281
    G0283 ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE


    ICD-9 Codes that Support Medical Necessity
    Group 1 Paragraph: N/A

    Associated Information
    Documentation Requirements

    1. All documentation must be maintained in the patient?s medical record and available to the contractor upon request.
    2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service(s)). The record must include the physician or non-physician practitioner responsible for and providing the care to the patient.
    3. The submitted medical record should support the use of the selected diagnosis code(s). The submitted CPT/HCPCS code should describe the service performed.


    Utilization Guidelines
    Treatment protocols utilizing multiple injections per day on multiple days per week for the treatment of multiple neuropathies or peripheral neuropathies caused by underlying systemic diseases are not considered medically necessary.

    Peripheral nerve injections will not be allowed unless medical records are reviewed and the services are approved during the redetermination process.

  4. #4
    Default
    I have this issue as well. I appeal with records that this is not related to a systemic disease and most of them get paid.

    Melissa Harris CPC
    The Albany and Saratoga Centers for Pain Management

  5. #5
    Location
    upper saddle river,nj
    Posts
    113
    Default
    Thank You, I have appealed all of the claims and we'll see. I'm in the state of NJ

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