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64622 & 64623

  1. #1
    Default 64622 & 64623
    Exam Training Packages
    Dr performed a bilaeral on the L2, 3, 4 and 5 he wants to bill 64622 x 1 and 64623 x 7 should it be billed that way I disagree need to help to code the right way how should it be billed. Thanks

  2. #2
    Default
    (These are my opinions and should not be construed as being the final authority. Other opinions may vary.)

    Assuming it was a neurolysis:

    64622-50
    64623-50 x 3

    If it was a Medial Nerve Block:

    64493-50
    64494-50
    64495-50

    If it was a Transforaminal:

    64483-50
    64484-50 x 3

    Richard Mann, your pain management coder
    rkmcoder@yahoo.com

  3. #3
    Default
    "Just over 60 percent of the overpaid services were instances in which the physician billed incorrectly for bilateral facet joint injections. Of the miscoded services that were overpaid, 61 percent were instances in which the physician incorrectly billed CPT add-on codes to represent bilateral facet joint injections instead of using modifier 50. Specifically, they billed multiple lines of CPT add-on codes 64472 or 64476 in addition to a primary code. Physicians should use add-on codes to represent additional levels of the back injected, not sides. As previously noted, the NCCI manual and “Medicare Claims Processing Manual” require that physicians use modifiers to indicate when they are billing for bilateral facet joint injection services. For example, a physician billing two add-on codes to represent a bilateral service receives......."

    http://oig.hhs.gov/oei/reports/oei-05-07-00200.pdf

    You need to bring this to your physician attention. If the physician is going to assist in the coding they have to be aware that they need to use the 50 modifier to indicate bilateral.
    http://www.cms.gov/MLNMattersArticle...ads/MM6518.pdf

  4. #4
    Location
    St. Joseph County, Indiana
    Posts
    101
    Default
    Amen. Please spread the word. This bilateral facet issue is wrecking it for the rest of us with more scrutiny, more appeals, and lower reimbursement.

    I'm just waiting for the AMA and CMS to bundle unilateral and bilateral injections into the same code.

  5. Default Biller
    Im having problems billing medi-cal 64622 with a modifier ag and 64623 x 2 bilateral when i put modifier 50 medi-cal denieds it and they want modifier 51 instead please help

    medi-cal this is the way i bill medical managed cares
    64622 x 1 (ag) 64622 x 1 (ag) and it gets paid
    64623 x 2 (51) 64623 x 2 (50)

  6. Default
    Quote Originally Posted by luisamedina2005@yahoo.com View Post
    Im having problems billing medi-cal 64622 with a modifier ag and 64623 x 2 bilateral when i put modifier 50 medi-cal denieds it and they want modifier 51 instead please help

    medi-cal this is the way i bill medical managed cares
    64622 x 1 (ag) 64622 x 1 (ag) and it gets paid
    64623 x 2 (51) 64623 x 2 (50)



    What is the date of service? These codes are no longer active as on January 2012.

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