Neurology & Pain Management Coding Alert

Question: We submitted 64483 and 99144 for procedures during the same patient encounter, but insurance denied the claim. Do we need to append a modifier to 99144?

Colorado Subscriber

Answer: CCI edits don't bundle 64483 (Injection[s], anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance [fluoroscopy or CT]; lumbar or sacral, single level) and 99144 (Moderate sedation services [other than those services described by codes 00100-01999] provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; age 5 years or older, first 30 minutes intra-service time). That means you shouldn't need a modifier. However, patients don't normally need moderate sedation before receiving an injection. Check your provider's documentation supporting the reason for moderate sedation, and check the policies for the payer in question.

Another idea: Verify the type of imaging guidance your provider used for the injection. Code 64483 includes fluoroscopic or CT guidance. If your physician used ultrasound guidance, you should report 0230T (Injection[s], anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level) instead of 64483.