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Thread: New RFA Coding

  1. #1

    Default New RFA Coding

    AAPC: CPC Promo
    With the new codes im unsure if this is correct we received a denial from BC but they were not sure why this denied out and are suppose to be calling back.

    Procedure was Right L2-L5 RFA with Fluoro
    We coded-
    64635
    64636
    64636

    Blue Cross paid first 2 lines and denied last line as-The charge exceeds the allowable amount for this service.

    Any help would be great appreciated

  2. #2
    Join Date
    Apr 2007
    Posts
    51

    Default

    That is correct because that would be L3-L4, L4-L5 and L5-S1 facets.

  3. #3

    Default New RF codes & modifiers

    I'm having the same issue with Medicare. They are only paying one level of 64634 or 64636. When we called to inquire why we were told we needed to add a modifier to the 3 level but wouldn't say which one. Their system assigned modifier 51 to one of the 64636 codes. I'm thinking perhaps we need to add modifer 76 on the 3rd level.

    Any thoughts on this?

  4. #4
    Join Date
    Apr 2007
    Posts
    44

    Default

    I didn't think it was necessary to put a modifier on an add-on code.

  5. #5
    Join Date
    Apr 2007
    Posts
    1,478

    Default

    If you are billing only right or left side procedures for 3 levels for example

    64635-RT
    64636-RT x 2
    additional note box 19 or electronic field stating

    2 additional levels performed on RT side

    I use additional note field every time I am billing multiple units with add on codes to confirm I am aware of the number of levels I am reporting and the note corresponds with the quantity billed on claim.

    If you are billing on separate lines as such
    64633-50
    64634-50
    64634-50

    They might be placing the 51 modifier on the third level in order to bypass their software from denying it as duplicate. You would need to check with the carrier you are billing regarding 76 or 59.

    For example, WPS Medicare J5 does not accept 76 modifier on non radiology procedure/surgery codes. They also do not accept 59 modifier when the codes reported are not recognized by NCCI as code pair. But these modifiers might be necessary based on the carrier's request or processing necesscities. Trying multiple ways of reporting and corresponding with their customer service to possible give a hint of "how to bill" is also sometimes necessary.

  6. #6

    Default

    We stick on a 59 modifier on the third line and it pays every time.

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