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Bilateral Lumbar/Cervical facet

  1. #1
    Question Bilateral Lumbar/Cervical facet
    Medical Coding Books
    When billing bilateral Lumbar/Cervical facet injections under floroscopic guidence on four levels how would you bill that?

    CPT units modifier
    64490/64493 2 50
    64491/64494 2 50
    64492/64495 2 50
    64492/64495 2 50
    77003 1 26


    I know that the text under 64492 and 64495 states "Do not report code 64492 and 64495 more than once a day" I'm wondering if it's different when the procedure it done bilaterally or if I'm supposed to bill 64492 & 64495 with 4 units? Please will someone clarify this for me?

  2. Default
    I would append modifier 59 to the second 64492 and 64495 because it is a separate distinct procedure.

    Also 77003 is only useable for destruction by neurolytic agent, otherwise CT fluro and U/S guidance are bundled

  3. #3
    Default
    with add on codes alot times you will use units to relay how many levels you did performed. Using the 50 modifier would work better with codes that are per level reported, to point out that a single code is representing a single level and the modifier painting the picture of the injection procedure being perform on the right and left facet joint area.

  4. #4
    Location
    Jacksonville Beach, FL
    Posts
    71
    Default
    I agree, I would use a 59 modifier on the second 64492, and 64495 for each side.
    AWest

  5. #5
    Location
    St. Joseph County, Indiana
    Posts
    101
    Default
    I completely disagree.

    The 64492 and 64495 expressly state they are to be used for "third and add'l levels". How can you jusitify billing them two times? Four levels should be just 64490, 64491 and 64492 with no fluoro. Bilateral should just be 64490-50, 64494-50 and 64492-50.

    If your 59 modifier actually works, I have 300 MBB's to fix from 2010.

  6. #6
    Location
    Jacksonville Beach, FL
    Posts
    71
    Default
    You are correct, I mis read that. The code 64492 can only be billed once per side, so I wouldn't use the 59, you will only need the modifier 50 and of course fluro is included with these codes.
    AWest

  7. #7
    Question so just to clarify..
    The proper way to bill bilateral cervical/Lumbar injections on four levels is:

    CPT Code Units Modifier
    64490/64493 2 50
    64491/64494 2 50
    64492/64495 4 50


    ?

  8. #8
    Default
    I have steered away from using quantity billing, modifier 59, and modifier 51 on the following codes 64490-64495.A code set selection as a break out of a bilateral procedures billed as for example 64490 RT 64490 LT 64491 RT 64491 LT 64492 RT 64492 LT or the only other option is 64490 50 64491 50 64492 50 There could be a 4th level performed such as C2-C3, C3-C4, C4-C5, C6-C7 but there still is only three codes that could potetially be reported since the final code ends with the statement or an instruction: "and any additional levels" 4th, etc....

  9. #9
    Location
    Jacksonville Beach, FL
    Posts
    71
    Default
    Quote Originally Posted by cronicizo View Post
    The proper way to bill bilateral cervical/Lumbar injections on four levels is:

    CPT Code Units Modifier
    64490/64493 2 50
    64491/64494 2 50
    64492/64495 4 50


    ?
    The way I would bill it is

    Cervical:
    64490
    64490-50
    64491
    64491-50
    64492
    64492-50

    Lumbar:
    64493
    64493-50
    64494
    64494-50
    64495
    64495-50


    Fluro:
    77003-26



    The most you can bill for 64492 and/or 64495 is one per side.
    Last edited by awest; 01-24-2011 at 12:52 PM. Reason: not lining up correctly
    AWest

  10. Wink
    billing for facet inj, it goes by the levels for c/t 64490 single level for bilateral just add mod 50 to 64490 on one, you can't put 64490 and 64490 mod 50. same for 2nd level 64491 thrid any any add'l levels 64492. Also with l/s single level 64493, 2nd level 64494 and third and any other 64495. fluroscopy is bundled with these codes so you can't bill for 77003

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