Anesthesia Coding Alert

Question: When billing for multilevel radiofrequency, we report 64622 for the first level and +64623 for each additional level up to a total of four. Our payers deny the fourth level as a duplicate, even when we append a modifier. How should we differentiate between the third and fourth levels so they'll both be reimbursed?

New Jersey Subscriber

Answer: You're correct in reporting 64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level) for the first level and +64623 (...lumbar or sacral, each additional level [List separately in addition to code for primary procedure]) for additional levels.

Option: You might need to include an additional note stating "3 additional levels" next to +64623. If all the levels were on the same side, you could also bill the add-on codes as a single line item and 3 in the "units of service" field, 24G of the 1500 form. For example, report 64622-RT (Right side) on line one of your claim and +64623 x3 RT on line two. Include any codes for fluoroscopic guidance, such as 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, subarachnoid, or sacroiliac joint], including neurolytic agent destruction).

Some payers won't pay for multiple units; others have certain ways to submit the claim; still others limit the number of levels the physician can ablate during a single session. An electronic system might not allow you to bill more than one modifier, which means you should submit a paper claim. Because of these types of variances, check your local guidelines to determine the best way to submit the claim.