Page 1 of 3 123 LastLast
Results 1 to 10 of 24

New Facet Codes with Medicare

  1. Default New Facet Codes with Medicare
    Exam Training Packages
    Hi,
    I've a quick question, when coding bilateral procedures I normally use a RT and LT modifier but for codes 64492 and 64495 in the CPT it states to only report those codes once per day. I tried to use the RT/LT modifiers and recieved a pop up from 3M Encoder staing not to uses these codes more than once per day. Should we go back to using a 50 Modifier.

    Any insight would be greatly appreciated.
    Thanks,
    Bella

  2. #2
    Default
    Unfortunately this is not an answer. I just came up with the same question. We use Custom Coder and there are no modifiers listed for the facet codes. Are they now to be treated like epidurals and don't get separate coding by LT/RT?

  3. #3
    Default
    Medicare still requires ASC's to bill bilateral procedures using LT and RT, so go ahead and override that pop up and bill it on two separate lines.
    Walker Bachman, CPC, CPPM

  4. #4
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    I agree with Walker. The coding programs we use (I use Encoder) do not take into account the ASC rules. I would override and bill accordingly.
    Mary, CPC, CANPC, COSC

  5. #5
    Default
    Not a problem overriding the LT/RT, but what about the statement that 64492 and 64495 are only to be billed once per day. What do you do in this case when you have bilateral injections, 3 levels each?

  6. #6
    Default
    I think what they meant is that you aren't to bill those codes once for the third level and again for the fourth level. In the case of Medicare ASC's, when you bill 64495-RT & 64495-LT, you are really only billing one level after all, so you aren't really violating the directive.

    ASC three levels bilateral for Medicare:

    64493-RT
    64493-LT
    64494-RT
    64494-LT
    64495-RT
    64495-LT
    Walker Bachman, CPC, CPPM

  7. Default
    Does anyone happen to have documentation for this from Medicare ???

  8. #8
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    Quote Originally Posted by bella2 View Post
    Does anyone happen to have documentation for this from Medicare ???
    which documentation are you looking for--the codes only billable once per day or to use RT/LT and that 50 is not a payable modifier in an ASC??
    Mary, CPC, CANPC, COSC

  9. #9
    Default
    If it makes you feel better, you can also code it like this:

    64493 x 2 units
    64494 x 2 units
    64495 x 2 units

    There hasn't been any directive from Medicare specifically regarding how to bill the new facet codes in an ASC. Without that, you must default to the standard way of billing bilateral procedures, which are the two scenarios described above. I'm sorry I couldn't provide any documentation. If I come across some, I will post it here.
    Walker Bachman, CPC, CPPM

  10. #10
    Default
    Quote Originally Posted by mbort View Post
    which documentation are you looking for--the codes only billable once per day or to use RT/LT and that 50 is not a payable modifier in an ASC??
    I think Bella is (understandably) having difficulty reconciling Medicare's bilateral procedure directive with the CPT guidelines for codes 64492 and 64495, which says to bill them only once per day.
    Walker Bachman, CPC, CPPM

Page 1 of 3 123 LastLast

Similar Threads

  1. Paravertebral facet injection -- Medicare
    By msingh23 in forum Orthopaedics
    Replies: 2
    Last Post: 09-29-2015, 09:44 PM
  2. Billing facet block injections to medicare
    By FCORBIN2 in forum Anesthesia
    Replies: 4
    Last Post: 08-05-2014, 07:21 AM
  3. ASC Medicare Reimbursement on Facet Injections
    By DCOMPauditor in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 09-06-2011, 01:58 PM
  4. Medicare/ Facet's in 2010 for an ASC
    By bella2 in forum Anesthesia
    Replies: 1
    Last Post: 01-11-2010, 02:36 PM
  5. Facet Blocks - new codes
    By marci_ann in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 01-07-2010, 09:38 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.