# Which reporting method is correct?



## Melissa*Ever*Evolving (May 29, 2013)

Please see the below options. Which is more appropriate?
Not finding any guidance from online insurance resources.
RF Ablation performed on three levels. Should we report as:
64635
64636 x 2

OR 

64635
64636
64636-59

We have a coding conflict in the office. 

Thank you for your help!

~Melissa, CPC


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## tgomez12 (May 29, 2013)

I code for an ASC and when I code these I code:

64635 LT/RT
64636 LT/RT
64636 LT/RT


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## Melissa*Ever*Evolving (May 29, 2013)

Thanks for your response!
I do add the (-RT/-LT/-50) always. 
We have problems with the second 64636 paying without the -59 modifier stating it is a duplicate service.


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## dwaldman (May 29, 2013)

One thing you could consider is adding additional note on the claim on the second line such as for example performed on the RT side:

64635-RT
64636*RT X2 

On the second line place additional note to go electronically or to appear on paper claim stating:

2 additional levels performed on the right side

I personally put additional notes on all add codes with quantity greater than one or if I bill a CPT that has multiple units of service I place a note stating the number levels performed regardless the carrier.


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## mitchellde (May 30, 2013)

In the MCM it states that surgical services should be billed with units of 1, therefore to bill multiples you should list a separate line with a 59.  I know some carries do accept the multiple units but all accept the two lines with the 59 modifier.
Also anything in the 10000-69999 range is considered a surgical service.


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## marvelh (May 30, 2013)

I'm curious - where in the MCM is this stated?  Which manual?  Which chapter?


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## dwaldman (Jun 3, 2013)

Below is from the internet only manual, they describe using units to identify the number of services performed. I was unable to find any guidance of billing add-on codes on separate lines with the 59 modifier. 


FL 46 - Units of Service  
Required.  Generally, the entries in this column quantify services by revenue code category, e.g., number of days in a particular type of accommodation, pints of blood.  However, when HCPCS codes are required for services, the units are equal to the number of times the procedure/service being reported was performed.  


Chapter 25 - Completing and Processing the Form CMS-1450 Data Set [PDF, 471KB] 

Above is from 100-04 Chapter 25 of the Medicare Internet only manual Page 34
Below is from 100-04 Chapter 26 of the Medicare Internet only manual Page

Item 24G - Enter the number of days or units.  This field is most commonly used for multiple visits, units of supplies, anesthesia minutes, or oxygen volume.  If only one service is performed, the numeral 1 must be entered.  
Some services require that the actual number or quantity billed be clearly indicated on the claim form (e.g., multiple ostomy or urinary supplies, medication dosages, or allergy testing procedures).  When multiple services are provided, enter the actual number provided.  
For anesthesia, show the elapsed time (minutes) in item 24g.  Convert hours into minutes and enter the total minutes required for this procedure.


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