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New Facet Codes with Medicare

  1. Default
    Medical Coding Books
    Thanks everyone for taking the time to respond to my question, this is such a wonderful group of people on this forum
    For now I'm billing out the bilateral injections for Medicare with the RT/LT modifiers, and all other commercial payers by the CPT guidelines.

    Thanks again to everyone for responding,

  2. Lightbulb 64490-64495 bilaterally
    I am dying here, attended conference in Orlando, that clearly states to use the 50 Modifier on bilateral injections and now no one is paying HELP, I dont feel the RT and LT are correct>>>

  3. #13
    Use of New Facet Injection Codes for 2010 Written by Paul Cadorette CPC, CPC-H, CPC-P, CEDC, COSC, CASCC | Tuesday, 12 January 2010 22:10 | More Tags: CPT 20550 | CPT 64490 | CPT 64493 | CPT 64999 | mdStrategies

    Editor's Note: This article by Paul Cadorette, director of education for mdStrategies, originally appeared in The Coding Advocate, mdStrategies free monthly newsletter. Sign-up to receive this newsletter by clicking here.

    CPT copyright 2008 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

    1. Report one code per level, but you can only report up to three levels. When documentation reads injection at C5-C6 and C6-C7, two levels are represented, so report CPT codes 64490 and 64491. When the documentation reads injection at C5, C6 and C7 (medial branch blocks) that would be three different levels reported with three CPT codes 64490, 64491 and 64492.

    2. CPT code 64492 and 64495 represent third and any additional levels so you would NEVER report more than three facet injection codes for cervical/thoracic or three facet injection codes for lumbar/sacral regions.

    3. Fluoroscopy or CT guidance are considered components of the CPT code so these types of image guidance would not be additionally reported, BUT USE OF FLUOROSCOPY OR CT IS REQUIRED TO ACCOMPLISH THE PROCEDURE – SO, IF IMAGE GUIDANCE IS NOT USED YOU WOULD REPORT 20550-20553.

    4. Parenthetical notes in the CPT book are incorrect — they state if ultrasound guidance is used report 64999. THIS IS WRONG. When ultrasound guidance is used report the appropriate Category III code from the 0213T-0218T range. These codes are not listed in your CPT book but can be found on the AMA Website.

    5. Facet Injections performed at the T12-L1 level should be reported with CPT code 64493 LUMBAR — this differs from CPT Assistant guidance that tells us to report 62310 (cervical/thoracic) when an epidural injection is performed at T12-L1. (Dec. 05 Special Issue Q&A)

    6. Although the codes have changed you can still report bilateral procedures with modifier -50 or RT/LT as appropriate.

  4. #14
    The above post notwithstanding, Medicare contractors will NOT accept mod-50 on a claim coming from a facility. They want you to use the left and right modifiers instead. Professional claims should use the mod-50.
    Walker Bachman, CPC, CPPM

  5. #15
    I do believe that it reports -50 or RT/LT AS APPROPIATE

  6. #16
    Quote Originally Posted by lgentry View Post
    I do believe that it reports -50 or RT/LT AS APPROPIATE
    I must disagree. I will quote Medicare:

    "Bilateral procedures should be reported as a single unit on two separate lines or with “2” in the units field on one line, in order for both procedures to be paid. While use of the -50 modifier is not prohibited according to Medicare billing instructions, the modifier is not recognized for payment purposes and if used, may result in incorrect payment to ASCs. The multiple procedure reduction of 50 percent will apply to all bilateral procedures subject to multiple procedure discounting."

    Here is the complete article:
    Walker Bachman, CPC, CPPM

  7. #17
    Quote Originally Posted by lgentry View Post
    I do believe that it reports -50 or RT/LT AS APPROPIATE
    This is true for professional physician billing, but not ASC's (see above).
    Walker Bachman, CPC, CPPM

  8. #18
    I am not disagreeing with you. I am saying that use 50 for private and lt and rt for Medicare. "As Appropriate" to me means just that if you have Medicare code what is appropriate for Medicare if you have private code 50 or LT/RT however they process the claim. Its all good!

  9. #19
    How would you bill facet injection (to commercial insurance) performed at, as an example; to L3/L4 and L4/L5 bilateraly?
    is this correct?

    64493.50 (2 units)
    64494.50 (2 units) or

    64493.50 (1 unit since we are billing modifier 50)
    64494.50 (1 unit)

    Thank you for your help


  10. #20
    64493-50 x1
    64494-50 x1
    Walker Bachman, CPC, CPPM

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