Neurology & Pain Management Coding Alert

Question: One of our private payers is denying when we bill 64633 and +64634 (with 3 units). They say we’re billing too many units. Is there a restriction to how many add-on units we can include on a claim?

Virginia Subscriber

Answer: Your codes 64633 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; cervical or thoracic, single facet joint) and +64634 (… cervical or thoracic, each additional facet joint [List separately in addition to code for primary procedure]) should be acceptable. Look into some other factors to learn why the payer might be denying the claim.

First, verify that the associated diagnosis codes are related to the procedure. Possibilities could include spondylosis without myelopathy (721.0 for cervical, 721.2 for thoracic, or 721.3 for lumbar) or post-laminectomy syndrome (722.81 for cervical, 722.82 for thoracic, or 722.83 for lumbar). 

Next, include modifier 59 (Distinct procedural service) on the second and third units of 64634. That notifies the payer that the physician performed the same service, but to multiple areas.

Finally, double check whether the provider is administering bilateral injections. If so, you’ll need to append modifier 50 (Bilateral procedure) to each CPT^® code. The payer might also want you to specify the number of units you’re reporting for each code.

Tip: Some payers deny these claims because they consider the procedure investigational. Many coders recommend filing a paper claim with documentation and a note in the narrative stating the procedure was not for investigational purposes.

Heads up: Some payers have utilization limitations in their coverage policies with limits to the number of levels of destruction. For example, the First Coast LCD states, “it is not expected that paravertebral facet joint destructions (median branch) will exceed five (5) levels, unilaterally or bilaterally on the same date of service.” If the payer has a utilization limit for facet joint destruction and your provider’s documentation supports the medical necessity for exceeding the limitation, be prepared to appeal the denial with documentation.