Prohibits billing codes for lumbar facet injection or denervation with these These nerves would be reported with only a single code (64451 or 64625). L5, S1, S2, and S3 nerves all innervate the SI joint, treating all four of Of nerves innervating the SI joint are reported only once regardless of the Of Nerves Innervating the Sacroiliac JointĬodes 64451 (injection) and 64625 (radiofrequency ablation) Issues with New Codes for Injection or Radiofrequency MUE for 64421 does reflect the 2020 change, allowing 3 units per day. Will be fixed with the second quarter updates effective April 1 st.The ItĪppears this was not communicated to NCCI, as the edits still bundle Coders are now instructed to reportĦ4420 for the first level and 64421 for each additional level injected. Multiple was a stand-alone code reported when more than one intercostal levelĬhanged 64421 to an add-on code to 64420. In the past, CPT code 64421, intercostal nerve block, However, theyĪdvised our client to wait at least 30 days before resubmitting theĭenials for these new codes and contact your payers about correcting theirĭatabase tables and the recommended timeline to resubmit your claims. Medicare, who we understand has corrected the system error. Similarly, MACs are denying new CPT codes 64451, 62328 andĦ4624 when reported with POS 11.
Place of Service System Errors for New Codes 64451, Carefully check denials on your pump refills/programming. Other CMS carriers may still be incorrectly denying the service based on this We understand that Palmetto GBA Medicare has fixed this mistake, but It has been reported that some Medicare MACs are denying pumpĪnalysis/reprograming when billed with POS 11. Place of Service System Errors for Pump Analysis and Probably best to continuing to report the 50-modifier with add-on codes. If no other reference or directive is found, it is Several commercial payers are also denying thisīilling methodology based on utilization levels.
With the 50-modifier, disregarding the new CPT instruction. TheyĬontinue to require all bilateral procedures (including add-on codes) to be billed Palmetto and First Coast are rejecting the -RT and -LT line items. We’ve been told so far, Medicare MACS Novitas, Separate line items, appending modifiers -RT and -LT (64484-RT and 64484-LT). However, the code(s) for each additional level are to be reported as two Think, for example, facet and transforaminal Incorrectly denied or improperly paid claims.ĬPT 2020 informed us of a change in reporting bilateral Prevent coding and billing headaches or at least assist you in appealing I hope the information below will help to Saying goes, identifying the problem is half the battle. I can’t resolve the difficulties, but, as the Issues, so I decided to share our discoveries with all of you. I have been contacted several times a day requesting help with these Quarter and as predicted, the new CPT codes and updates are causing problemsįor anesthesia and pain management groups. Well friends, we are more than halfway through the first
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