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Facet injections

  1. #1
    Red face Facet injections
    Medical Coding Books
    I am new to pain management so forgive me if this is a dumb question!

    I am receiving denials (from Medicare) for my additional level codes on bilateral injections. Can anyone give me an example of exactly how I should bill procedures 64470 and 64472 when there was a total of 4 bilateral injections done?

    Thanks in advance!!
    Jessica

  2. #2
    Default facet injections
    how many levels were injected? facet joint injection codes are unilateral, you can append bilateral modifier 50 when they are injected on both sides at the same level. if you're coding just two levels, it would be coded as: 64470-50 and 64472-50. an example of one level would be L3-L4. I hope this helps.


    Leah

  3. Default
    Do you work at an ASC??? ASC billing for MCR::::Bilateral is 644770 LTRT, 64472 LTRT59.
    Hope this helps

  4. #4
    Location
    Columbia, MO
    Posts
    12,867
    Default
    Just be sure you are not using LT and RT on the same line item, LT and RT are anatomic modifiers and you may assign only one anatomic modifier per line item. so it should look like this:
    64470 LT
    64470 RT
    64472 LT
    64472 RT
    There is no need for a 59 modifier as the 64472 is an add on code.. also you could bill it as:
    64470 50
    64472 50
    the difference is really which payer you are billing.

  5. #5
    Default
    I also do billing for an ASC and for Medicare only, if you don't put the 59 modifier even though the 64472 is an add on code, it will get denied...it shouldn't be necessary but that is the way Medicare process their claims. I have tried it before and I always end up doing Medicare Reviews having to add the 59 modifier and that is how they pay it.

    hope this helps!
    NoRaX

  6. #6
    Default
    The way I was told to bill them is:

    64470-50
    64472-50x3

    I am billing for the physician, not the ASC. Medicare denies the 64472-50x3 as invalid beginning/end dates and/or units of service, but I've been told that breaking them up such as

    64470-50
    64472-50
    64472-50
    64472-50

    will only get the last two add ons denied. Do I need to add the -59 modifier to both of those lines then?

    Thanks everyone for your help!!!!!

  7. #7
    Default
    I code/bill for an ASC and I do
    64470 RT
    64472 RT
    64470 LT 50
    64472 LT 50

    We get paid!

    One time MC told us to do it this way
    64470 50
    64472 50
    But then we did not get paid, and we called them, they then told us to do it the old way, and we get paid again!

  8. Default MC LCD for facets
    Also remember that CMS has an LCD for facet blocks that limits the number of levels that will be paid without supporting documentation.
    The LCD reads:

    No more than three levels, unilaterally or bilaterally, will be allowed for this procedure unless acceptable justification is presented.


    Carol

  9. #9
    Location
    Albany, New York
    Posts
    457
    Default
    In regards to response from "martn", why Medicare would want to see
    modifiers "LT 50" on one line item does not make sense.
    I bill Amg Surg for a hospital and have never been told by the billing office that denials are being received in the cases where I use modifier 50 on the CPT codes mentioned in the previous responses.
    I know there are cases where Medicare wants a HCPCS billed instead of a CPT (ie: Sacroiliac Joint injection), but don't understand why they would change the way modifiers are utilized based on Place of Service (??)
    Karen Maloney, CPC
    Data Quality Specialist

  10. #10
    Location
    Columbia, MO
    Posts
    12,867
    Default
    Karen I am confused also, a 50 and an LT do not belong together on the same line, as far as your 50 modifier denials the billing office says you are getting, have them check the number of units.. many times it happens that the billing office, or the software will add units of 2 when you put a 50 modifer on a line and the units is what causes it to deny the units must always be 1. Jessica if he truely did that many injections then you will need the 59 modifer to keep the additional levels from rejecting as duplicates.

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