# Bilateral Lumbar/Cervical facet



## cronicizo (Jan 20, 2011)

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?


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## kbazarte@yahoo.com (Jan 20, 2011)

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


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## dwaldman (Jan 21, 2011)

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.


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## awest (Jan 21, 2011)

I agree, I would use a 59 modifier on the second 64492, and 64495 for each side.


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## brockorama01 (Jan 21, 2011)

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.


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## awest (Jan 21, 2011)

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.


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## cronicizo (Jan 21, 2011)

*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     


?


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## dwaldman (Jan 22, 2011)

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....


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## awest (Jan 24, 2011)

cronicizo said:


> The proper way to bill bilateral cervical/Lumbar injections on four levels is:
> 
> CPT Code            Units             Modifier
> 64490/64493          2                  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.


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## tadavis (Jan 24, 2011)

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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## awest (Jan 24, 2011)

I have found that some carriers want one line with a modifier 50, others want 2 lines with the modifier 50 on the second line.  It all depends on the carrier and your contract, I have to bill both ways for our facility.  I forgot that the fluro is inclusive to these procedures again.


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## ctpepenelli (Apr 6, 2011)

*I think this is how it is meant to be reported....*



cronicizo said:


> The proper way to bill bilateral cervical/Lumbar injections on four levels is:
> 
> CPT Code            Units             Modifier
> 64490/64493          2                  50
> ...



This is how I see it:

C/T:
64490 50 x1
64491 50 x1
64492 50 x1

L/S:
64493 50 x1
64494 50 x1
64495 50 x1

Not sure why you would report 64490 on one line, then 64490-50 on the next.
64490 = first level, 50 = both sides. 
That appears to be incorrect, but as someone above said, every carrier is different.


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## purplescarf23 (Apr 6, 2011)

brockorama01 said:


> 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.






I agree with you here.  We bill these mulitple times during a week and I would bill them just as you have described above. 64490-50, 64491-50, 64492-50 & 64493-50, 64494-50, 64495-50.  Hope that helps whoever is trying to bill these.  

Kelsey, CPC


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