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FACET QUESTION IN ASC - need clarification

  1. #1
    Location
    Pensacola , Florida
    Posts
    122
    Default FACET QUESTION IN ASC - need clarification
    Medical Coding Books
    I am being told one thing that makes no sense to me ..and yet what I am reading from AAPC still makes no sense

    example : if done bilaterally ??
    New codes 64493,64494,64495

    I am told not to bill more than three lines ! ever

    But that just does not seem right - what if they are bilateral ?
    (still told not to bill more than 3 lines )

    Yet what I am reading says this " the new codes have a different code for each level billed (1st - 3rd)
    The last code *64495* or *64492* is for the 3rd LEVEL and those codes state the code "cannot be billed more than once per day", which in CPT rules means that only a maxium of 3 levels are allowed to be billed."

    What is the "once per day rule" applying to ? The last code only ? or all three?

    If 4 levels were done Bilaterally is this correct ??
    64490RT
    64490LT
    64491RT
    64491LT
    64492RT ( only once ? )

    Only THREE levels would be billed by doing this ...right ?

    OR

    64490RT
    64491LT
    94492RT

    Please clarify this for me ... I feel that the second way is just not right ?

    Thanks in advance!

  2. #2
    Default
    ASC billing only...

    Three levels bilateral for commercial insurance:
    64490-50
    64491-50
    64492-50

    Three levels bilateral for Medicare:
    64490-RT
    64490-LT
    64491-RT
    64491-LT
    64492-RT
    64492-LT

    If a 4th level is done, you do not bill for it because 64492 includes payment for the third level AND any additional levels.
    Walker Bachman, CPC, CPPM

  3. #3
    Location
    Pensacola , Florida
    Posts
    122
    Default
    thank you thank you thank you !!!!

  4. #4
    Default
    Welcome Welcome Welcome!!!
    Walker Bachman, CPC, CPPM

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