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need help fast RE: nerve block injection unbundling

  1. #1
    Location
    Everett, WA
    Posts
    886
    Default need help fast RE: nerve block injection unbundling
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    Help, please, 64405 (bilateral occipital injection) and 64450 (other peripheral nerve or branch). Both of these procedures were done on the same day of service for a migraine sufferer. Aetna denies 64450 as inclusive to 64405. Chart notes do not warrant the use of modifier 59. Is this their particular "oddity" as it is for UHC to always deny the 64405? EM service was involved too, but that's not my question. It was billed out as:
    99213-25,
    64450-50-51 (placement of the modifier 51 here might have triggered a rejection perhaps due to a billing error?
    64450-51,

    64405-51
    64405-50,51,
    64400-51,
    64400-50,51.

    I'm thinking a corrected claim and future appeal may be in our future. All lines paid except the 64450.
    ---Suzanne

  2. Default
    I am in search for nerve block injection for a hip! Not trying to be a know it all....,on your question, but you realize this is not a code for injection? It is for infusion and these codes are not allowed in the office typically unlless you have provisions regarding a clinical procedure room? You may already know this, but i saw the ee/m code and thought hmm..............

  3. #3
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    Aetna does have their own set of edits that don't always follow CCI edits. Based on the coding you gave, I agree that the first line should not have also had a 51 modifier; I would correct the claim and appeal, showing from the notes that three different nerves were blocked; trigeminal, occipital, and the other one (peripheral nerve or branch). Also, I have never heard that these can't be performed in the office - (per the earlier reply from mancoder); I've coded for Physical Medicine and Rehab, and they do these in the office all the time. Thanks,

  4. Default
    Our pain center bills for these often. 64405 is the occipital block. 64450 other peripheral is for the occipital as well. But, there is the greater and the lesser nerves. I cannot remember which one, but one of the codes represents the greater nerve and the other represents the lesser. When I bill these, I don't put modifiers on any and we get paid.

  5. #5
    Location
    Columbia, MO
    Posts
    12,570
    Default
    Quote Originally Posted by ollielooya View Post
    Help, please, 64405 (bilateral occipital injection) and 64450 (other peripheral nerve or branch). Both of these procedures were done on the same day of service for a migraine sufferer. Aetna denies 64450 as inclusive to 64405. Chart notes do not warrant the use of modifier 59. Is this their particular "oddity" as it is for UHC to always deny the 64405? EM service was involved too, but that's not my question. It was billed out as:
    99213-25,
    64450-50-51 (placement of the modifier 51 here might have triggered a rejection perhaps due to a billing error?
    64450-51,

    64405-51
    64405-50,51,
    64400-51,
    64400-50,51.

    I'm thinking a corrected claim and future appeal may be in our future. All lines paid except the 64450.
    ---Suzanne
    Why do you have one line with a 50 51 and then the same code with just a 51? I was taught in anatomy class that nerves are not inherently bilateral so you should use the 59. You are showing three 64450 injections etc is this correct?

    Debra A. Mitchell, MSPH, CPC-H

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