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Someone proficient in coding Facet Blocks

  1. #1
    Exclamation Someone proficient in coding Facet Blocks
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    the paragraph below is in the recent Edge Blast. the last paragraph is what is stumping me. It states to not report the +64476 as multiple charge lines.
    This is how I've been billing:
    64475-RT L3
    64476-RT L4
    64476-RT L5
    64476-RT S1
    77003

    When reading the last paragraph do you interpret that we report the +64476 once with 3 units?
    Thank You,
    Susan G
    The National Correct Coding Initiative Policy Manual (NCCI manual) for Medicare Services and the Medicare Claims Processing Manual state that you should use modifiers to indicate when a service differs from CPT® definition. Up to two modifiers are allowed for each CPT® code on a claim. Use modifier 50 bilateral procedures to indicate bilateral facet joint injections performed on both the right and left sides of a level. This increases reimbursement to 150 percent of the base rate. If a physician performs multiple bilateral injections, attach modifier 50 to each facet joint injection code.

    Primary codes 64470 Injection; Paravertebral facet joint or facet joint nerve; cervical/thoracic, single level and 64475 Injection; Paravertebral facet joint or facet joint nerve; lumbar/sacral, single level include pre-surgical and post surgical expenses related to the procedure. Use add-on codes to represent additional levels, not sides. Do not bill multiple lines of CPT® add-on codes +64472 Injection; Paravertebral facet joint or facet joint nerve; cervical/thoracic, each additional level and +64476 Injection; Paravertebral facet joint or facet joint nerve; lumbar/sacral, each additional level in addition to the primary code.

  2. Default
    That is exactly how we bill in Arizona for our facet joints and we are always paid. We have found billing all on one line, we had to constantly appeal, as insurance carriers were "missing" how many units we billed out or paying at a lower level of reimbursement.

    Sam

  3. Default Facet Blocks
    We have also had difficulty, particularly with Medicare, when billing multiple units on one line ie 64476 (X3) I would continue to bill them each as a seperate line items with the side LT - RT or 50 modifier appended. I don't know why the edgeblast said that!!! I think it must have been a mistake.

    Example

    64475 - LT (1st level)
    64476 - LT (2nd level)
    64476 - LT (3rd level)


    Heather

  4. Default
    edge blast probably said that because you shouldn't have to bill out multiply lines for an add on code per CPT guidelines...they are not telling you how to bill pre Medicare guidelines which we all know are totally different. If you are billing any one else you can bill with units attached to the add on code. Only medicare wants them to billed one line at a time.

  5. #5
    Location
    St George, UT
    Posts
    37
    Default
    Quote Originally Posted by sgormsen View Post
    the paragraph below is in the recent Edge Blast. the last paragraph is what is stumping me. It states to not report the +64476 as multiple charge lines.
    This is how I've been billing:
    64475-RT L3
    64476-RT L4
    64476-RT L5
    64476-RT S1
    77003
    If you are targeting the L3, L4, L5 and S1 nerves, I would only bill
    64475 (L3-4)
    64476 (L4-5)
    64476-59 (L5-S1)
    77003

    The facets have been targeted by CMS as an area where overpayments are occurring due to the additional level being billed (and paid). The facet joint is innervated by the nerve above and below the joint so the doc must place 2 needles in order to effectively block the joint. You do not bill based on the # of needles placed, only the joints. When they do the RF, then you can bill for each level which would be 64622, 64623 x 3 for L3, L4, L5 and S1 for the above scenario.

    I don't have my magazines handy but I do believe that there was a correction/clarification noted in the following month's issue.
    Last edited by med-biller; 02-15-2009 at 09:12 AM.

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