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Medicare Compliance & Reimbursement

PHYSICIANS:

CMS Presents A Bundle Of Nerve-Block Edits

Published on Fri Sep 02, 2005

...but everyone expected feds to make the move.

Physicians performing procedures to destroy the somatic or sympathetic nerves soon won't be able to bill for a nerve block with those procedures.

Starting in October, a sweeping set of edits will bundle nerve block introduction/injection codes 64400-64413, 64418-64449, 64479, 64483 and 64505-64530.

Each of those codes will become a component of 51 or 52 other nervous system codes. The comprehensive codes include:

• codes 64612-64614, 64630 and 64681, for destruction of the somatic and sympathetic nerves by a neurolytic agent;

• neuroplasty codes 64702-64726;

• transection/avulsion codes 64732-64772;

• somatic nerve excision codes 64774-64776, 64782, 64784-64786, 64788-64795;

• sympathetic nerve excision codes 64802-64823
 
Also, 64400, 64402, 64420, 64421, 64430 and 64479 and 64483 and 64505 and 64508 are all components of miscellaneous nerve destruction code 64640.

"I knew this was coming," says Christina Olson, consultant and auditor with South Oakland Services in Warren, MI. The carriers have been "cranky" about paying for a nerve block on the same day as these other procedures, she says.

The carriers like to see a nice, tidy diagnostic pattern where the physician tries a nerve block first. If it provides temporary relief, the physician uses a neurolytic agent to destroy the nerve. Using a nerve block on the same date as a neurolytic agent muddies that picture, Olson explains.

Doctors should still be able to bill for a separate nerve block using a modifier, if the doctor is performing it on a different body part, notes Olson. For example, while the doctor is doing using a neurolytic agent on the lower back, she may try a nerve block on the upper back if the patient has both upper and lower back pain.

CCI 11.3 also deletes several other complicated edits: physicians will no longer need a modifier to bill for nerve-destruction codes 64622 and 64680 with half a dozen codes for injection of neurolytic agents and anesthetic agents. Similarly, four injection codes (62311, 62319, 64450 and 64475) are no longer components of nerve-destruction codes 64620 and 64626.

Also, injection code 62310 is no longer a component of nerve-destruction code 64623, 62311 is no longer a component of 64627, and 64470 is no longer a component of 64681.

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