Page 3 of 4 FirstFirst 1234 LastLast
Results 21 to 30 of 34

Line item denial for 64484

  1. #21
    Location
    Columbia, MO
    Posts
    12,867
    Default
    Medical Coding Books
    Thank you so much, I felt like I was out there riding the wave by myself on this one!

  2. #22
    Location
    Albany, New York
    Posts
    457
    Default
    Hello again....
    Please refer to the CPT Assistant below. It explains why codes 64480 & 64484
    were developed and should dispel the notion that modifier 59 has to be utilized when coding these procedures. As stated previously, I have coded 64484 (for multiple levels, as separate line items) to Medicare with only "anatomical" modifiers and have never been notified by our billing office as to denials for duplicate procedures.

    Transforaminal Injection(s): Single vs Multiple Levels

    To differentiate technique and code usage, the transforaminal epidural injection codes 64479-64484 describe both diagnostic and therapeutic nerve root injections that enter the epidural space through the intervetebral foramen requiring separate needle insertions at several unilateral spinal levels. This technique differs from interlaminar epidural injection technique (62310-62311) and the facet joint nerve injection technique (64470-64476). Fluoroscopic guidance and contrast material is used to localize the flow pattern (eg, either in the foramen and into the epidural space, or in a facial plane, or in an epidural vein). The needle is moved until contrast outlines the selected spinal nerve and flows into the foramen and then into the epidural space. Since the vertebral artery (in the cervical spine), radiculomedullary arteries, as well as the spinal cord are in close proximity to the nerve root, this procedure involves a much higher risk with more work than a translaminar epidural injection.

    Depending on the treatment required, multiple spinal levels may require injection (eg, foraminal stenosis from a variety of disorders, cervical spondylosis, lumbar spinal stenosis, postoperative back and leg pain, herniated discs in the far lateral or neuroforaminal position). Previous cervical or lumbar fusions make this procedure more difficult. In the case of a previous lumbar or cervical fusion, sometimes the only way to access the injured nerve root is through the transforaminal approach.

    Since there can be multiple levels of pathology, which may require more than one injection site for diagnostic and therapeutic reasons, codes 64480 and 64484 were established. When performing transforaminal epidural injections at different levels, the patient's position does not change, but a new injection at the different level is performed. Each level is a separate injection with more physician work needed. Multiplanar real-time fluoroscopic imaging is mandatory for any transforaminal injection. When a transforaminal injection is performed on the opposite side, the work may involve redraping and positioning of the patient. Therefore, when performing bilateral transforaminal epidural injections at a single spinal level, modifier 50 is appended to the appropriate code(s).



    CPT Assistant © Copyright 1990–2009 American Medical Association. All Rights Reserved
    Karen Maloney, CPC
    Data Quality Specialist

  3. #23
    Location
    Denver Colorado
    Posts
    284
    Question
    Actually I don't see in Chapter 26 - Completing and Processing Form CMS-1500 Data Set of the CMS Claims Processing Manual where it states that 24G can not be greater than 1 except for meds and timed based services.

    Here is what I found:
    Item 24G - Enter the number of days or units. This field is most commonly used for multiple visits, units of supplies, anesthesia minutes, or oxygen volume. If only one service is performed, the numeral 1 must be entered. Some services require that the actual number or quantity billed be clearly indicated on the claim form (e.g., multiple ostomy or urinary supplies, medication dosages, or allergy testing procedures). When multiple services are provided, enter the actual number provided. For anesthesia, show the elapsed time (minutes) in item 24g. Convert hours into minutes and enter the total minutes required for this procedure. For instructions on submitting units for oxygen claims, see chapter 20, section 130.6 of this manual. NOTE: This field should contain at least 1 day or unit. The carrier should program their system to automatically default "1" unit when the information in this field is missing to avoid returning as unprocessable.

    I have seen this field used to report multiple units of service for many different CPT & HCPCS codes and have payers adjudicate them correctly.

  4. #24
    Location
    Columbia, MO
    Posts
    12,867
    Default
    Here is the section out of the official 1500 billing guide which directly relates to the original question:
    Postoperative Pain Control Procedures
    When provided principally for postoperative pain control, peripheral nerve injections and neuraxial (spinal, epidural) injections can be separately reported on the day of surgery using the appropriate CPT procedure with modifier -59 (Distinct Procedural Service) and 1 unit of service.
    Examples of such procedures include:

    62310-62319 Epidural or subarchnoid injections
    64415-64416 Brachial plexus injection, single or
    continuous
    64445-64448 Sciatic or femoral injections, single or
    continuous
    64449 Lumbar plexus injections, continuous

    These services should not be reported on the day of surgery if they constitute the surgical anesthetic technique.

    NOTE: Modifier 59 requires that the medical record substantiate that the procedure or service was a distinct or separate services performed on the same day.

    This section follows the section which talks about units in general.

  5. #25
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    ok...I'm going to throw my head on the chopping block here..

    If the 2nd 64484 IS a 3rd level, then I would code as follows
    64483, 64484, 64484-59

    units would not be appropriate and nor would bilateral (50) if this is a 3rd level.

    my two cents

  6. #26
    Location
    Denver Colorado
    Posts
    284
    Question
    What "official 1500 billing guide" are you referencing? Chapter 26 of the CMS Claims Processing Manual does not include a section on postoperative pain management procedures

  7. #27
    Location
    Denver Colorado
    Posts
    284
    Question
    Are you referencing the ASA position paper "REPORTING POSTOPERATIVE PAIN PROCEDURES IN CONJUNCTION WITH ANESTHESIA" that was updated last September?
    http://www.asahq.org/publicationsAnd...andards/43.pdf

    Note that the transforaminal epidural injection codes (64479-64484) are not included in the list. Side note: rarely to never would transforaminal epidural injections be performed for postoperative pain control.

    I have seen providers report 3 levels of transforaminal epidural injections in a multitude of methods and have most payers process them correctly, such as

    64483 with 1 unit of service
    64484 with 2 units of service

    OR

    64483 with 1 unit of service
    64484 with 1 unit of service
    64484 - 59 with 1 unit of service

    OR

    64483 with 1 unit of service
    64484 with 1 unit of service
    64484 - 76 with 1 unit of service

    The method that is problematic with many payers is multiple line items that are identical...

    64483 with 1 unit of service
    64484 with 1 unit of service
    64484 with 1 unit of service

    The payer's claims processing software views line 2 & 3 as identical and processes the second line item as denied due to duplicate data entry. This denial can certainly be appealed but causes delays in collections and increases the work (cost) of the billing staff.

    Unfortunately, with HIPAA we didn't get payer uniformity with reporting simple things like bilateral procedures and/or multiple units of add-on codes! :>) Just those 2 issues could most likely reduce the costs of health care but in my mind "He who has the gold, has the power to determine how they want services reported." In essence, payers still have control of how we need to report these types of services and there isn't necessarily one size fits all or one solution that will work with all payers. Rats, if only we had the ideal world! :>)

  8. #28
    Location
    COASTAL CODERS-CONWAY,SC
    Posts
    68
    Default Who was the instructor
    Who was the instructor for your pain managment class?
    KATHY H. HARDWICK-CPC
    AYNOR, SC

  9. #29
    Location
    Denver Colorado
    Posts
    284
    Question
    or I found an identical excerpt from the NHIC Anesthesia Billing Guide: http://www.medicarenhic.com/provider...ng%20Guide.pdf

    But I don't see the reference to it would be incorrect to bill in field 24G with units for services other than drugs and time based codes. Certainly those codes in the list would most likely only be performed with a single unit of service, such as a continuous lumbar plexus infusion but that wouldn't necessarily preclude other services from being reported with multiple units of service. In fact, the Medicare Medically Unlikely Units indicate that there are many codes that can be reported with multiple units of service up to the MUE limit.

    Why I am looking for the specific reference is that just recently I looked into the issue of using 24G for reporting multiple units of service for other services for a provider and his biller & couldn't find anything that was in "black and white" that specified correctness or not.

    Thanks

  10. #30
    Location
    Columbia, MO
    Posts
    12,867
    Default
    There is an actual CMS billing manual it was updated Feb 08 and that is where this information comes from, of course many people will see the same information and interpret it many different ways. When you give two different injections at two different sites or excise two different lesions from two different areas, then these are not multiple units of the same service. each one is unique and different, I really cannot explain it any other way. Also when I have worked as a consultant, I have looked at numerous rejections and discovered many underpayments due to the use of units. I know it is done, I just do not agree with it nor is it correct.

Page 3 of 4 FirstFirst 1234 LastLast

Similar Threads

  1. Replies: 0
    Last Post: 10-04-2013, 01:51 PM
  2. POS and item 32 on CMS 1500
    By jewelrad in forum Compliance General Discussion
    Replies: 0
    Last Post: 03-06-2013, 02:03 PM
  3. Replies: 0
    Last Post: 10-18-2010, 09:57 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.