Self-Quiz: Hone Your ASC Pain Management Coding Skills

With payments on the wane for pain management services in the ASC setting, reporting claims accurately and completely is more important than ever before. See how you fare -- and perhaps pick up a few coding tips -- by challenging yourself to this pain management quiz.

Scenario 1: The physician performs bilateral cervical median descending branch nerve neurolysis via cryo-ablation at C4, C5 and C6. How should you report this?

A. 64626 x 3
B. 64626, 62427 x 2
C. 64626-50, 64627-50 x 2
D. 64626 x 2, 64627 x 4

Explanation: When reporting destructive nerve procedures (such as 64626, 64627), you should begin by counting the number of nerves the physician treats, says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting, in Denver.
The physician targets a paravertebral facet joint nerve (medial branch) destruction at the nerve location on the individual vertebra rather than the space between vertebrae. Therefore, if the physician documents, for instance, "C4 and C5 facet joint nerve destruction," this represents two separate nerves, and you would report it with two codes: 64626, Destruction by neurolytic agent, paravertebral facet join nerve; cervical or thoracic, single level; and +64627, …each additional level (list separately in addition to code for primary procedure).
Watch the limits: Some Medicare payers specify, "Performing more than two (2) to three (3) bilateral or unilateral joint level denervations per region (cervical, thoracic, lumbosacral) on the same date of service would usually not be anticipated and may be subject to review." If your specialist plans to treats more than three spinal levels, he should include clear documentation of the medical necessity for the increased number of spinal levels.
"Realize," Hammer says, "that it is quite unusual -- if not impossible -- to get preauthorization from a Medicare carrier. Commercial payers may do so, but for Medicare this is rare."
Because the facet joints are on either side of the vertebrae, physicians often -- as in this case -- perform procedures bilaterally. In an office setting, you would append modifier 50 (Bilateral procedure) to the appropriate codes to describe procedures at a single level on both the left and right. But this method isn’t appropriate to an ASC.
Although modifier 50 is on the list of modifiers approved for outpatient use, some payers (including Medicare) direct ASCs not to report modifier 50 and instead instruct you to report a bilateral procedure using two units of the applicable CPT code.
Specifically, Medicare guidelines instruct, "bilateral procedures should be reported as a single unit on two separate lines or with ‘2’ in the ‘units’ [...]

- Published on 2008-06-12