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Thread: CPT codes 64475 and 64476

  1. #1

    Default CPT codes 64475 and 64476

    If anyone has experience on coding for CPT codes 64475 and 64476, I will appreciate your help.

    When billing Medicare, I have a Pain Management provider who does MULTIPLE BILATERAL injections utilizing CPT codes 64475 and 64476. In the past, I used to bill these with a RT and LT modifier along with modifier -76 when multiple injections are done. Medicare has denied stating that the -76 modifier is not applicable for these CPT codes. I have also used strictly the 50 modifier (billing all on one line item for Medicare) for bilateral along with unit values based on how many injections the provider had done on each side, bilaterally. This scenario has also been denied, stating that I am unable to bill multiple units for 64476.

    Has anyone encountered this before? Does anyone have experience on how to appropriate bill for CPT codes 64475 and 64476?

    Thanks in advance.

    Jennifer Gauger, CPC
    Coding Department Supervisor
    ebix, inc.
    jenniferg@ebixinc.com

  2. #2
    Join Date
    Apr 2007
    Location
    Alexandria, LA
    Posts
    517

    Default

    Does your carrier have an LCD for facet joint injections? That would be the place to start.
    Otherwise, these should be coded with -50 for bilateral injections.
    If your carrier is denying with frequency, they may want -59 for the additional levels.
    By CPT if 3 levels were injected, for instance L1-L2; L2-L3; L3-L4 bilaterally, you would code 64475-50, 64476-50 x 3.
    You could try 64475-50, 64476-50, 64476-50-59, 64476-50-59, but I'd check the LCD first to see how they want them.
    77003 would only be coded once

  3. #3

    Default

    Thanks for the assistance. I did call our Medicare carrier and they do not have a policy for these codes. I did not try using the -59 modifier, only billing with the -50 modifier X3. This is what they denied as not being able to bill these codes with multi-units.

    Thanks for the suggestion of -59. I will try it.

    Jennifer Gauger, CPC

  4. #4
    Join Date
    Apr 2007
    Location
    Woodland Hills, CA
    Posts
    121

    Default

    I was just researching about CPT codes 64475 and 64476 and I found out this thread.
    I thought, we can't bill an add-on code with any modifier. Can someone please explain this situation, how come the add on code 64476 can be billed with modifier 50?

    Thank you,
    Lilit
    CPC CCS
    "The true way to render ourselves happy is to love our work and find in it our pleasure."

  5. #5
    Join Date
    Apr 2007
    Location
    Albany, New York
    Posts
    456

    Smile

    You cannot use modifier "51" with add-on codes.
    You can use modifiers that identify the laterality of the procedure(s).

    Also, due to the description of 64476 (each add'l level), modifier "59" is not required in these cases.
    Karen Maloney, CPC
    Data Quality Specialist

  6. #6
    Join Date
    Apr 2007
    Location
    Woodland Hills, CA
    Posts
    121

    Default

    Great, thank you very much Karen.
    Lilit
    CPC CCS
    "The true way to render ourselves happy is to love our work and find in it our pleasure."

  7. #7
    Join Date
    Apr 2007
    Location
    Woodland Hills, CA
    Posts
    121

    Default

    I have "Bilateral S1 neuroforaminal/sleeve root blocks" and the doctor billed for 64483, 64484-59, is this correct? If not, how is this supposed to be coded?
    Thank you,
    Lilit
    CPC CCS
    "The true way to render ourselves happy is to love our work and find in it our pleasure."

  8. #8
    Join Date
    Apr 2007
    Location
    Albany, New York
    Posts
    456

    Smile

    This would be coded 64483-50.
    Karen Maloney, CPC
    Data Quality Specialist

  9. #9
    Join Date
    Apr 2007
    Location
    Woodland Hills, CA
    Posts
    121

    Default

    Thank you Karen very much for your response.
    Lilit
    CPC CCS
    "The true way to render ourselves happy is to love our work and find in it our pleasure."

  10. #10
    Join Date
    Apr 2007
    Location
    Albany, New York
    Posts
    456

    Smile

    you are very welcome Lilit.
    Karen Maloney, CPC
    Data Quality Specialist

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