Neurology & Pain Management Coding Alert
Depend on Payer for Bilateral Reporting Guidance
Question: I need advice on how to code for Medicare versus commercial payers when reporting 64405 as bilateral. I've seen several different ways that coders report it. What kinds of guidelines exist? Louisiana Subscriber Answer: When submitting 64405 (Injection, anesthetic agent; greater occipital nerve) as bilateral, Medicare requires that you include modifier 50 (Bilateral procedure) with a single unit of service and one line item. The correct way to report the service for commercial insurers will depend on the payer. Some want modifier 50, some want you to report separate lines of 64405 with modifiers LT (Left side) and RT (Right side), some want you to include modifier 51 (Multiple procedures) to distinguish bilaterality. Directions for billing bilateral services should be included in the payer's provider manual.
Neurology & Pain Management Coding Alert
- Procedure Coding:
Ensure Your Documentation Helps Gain Plantar Fasciitis Reimbursement
Documenting every detail helps justify every treatment along the way. Heel pain affects nearly 2 [...] - Anatomy Refresher:
Understand the Plantar Fascia's Tissues
There are more layers than you might realize. The more you know about plantar fascia [...] - Documentation:
Explain Situations Clearly to Recoup Pay for 'Unlisted' Claims
Tip: Watch your units and modifiers. Filing claims with an “unlisted” procedure code is the [...] - ICD-10:
Let Spinal Location Guide Your Coding for Schmorl's Nodes
Hint: Additional choices will let you get more specific with ICD-10. About 30 percent of [...] - You Be the Coder:
Know Injection Site Before Choosing Procedure Code
Question: Our physician dictated the following: “patient has irritation of the soft tissues over the left [...] - Reader Questions:
Injection by PA Doesn't Automatically Mean 'Incident-to'
Question: The physician saw a new patient for evaluation in the hospital outpatient setting. He [...] - Reader Questions:
Always Submit the Most Definitive Diagnosis Code
Question: Though there are many crosswalks from ICD-9 to ICD-10, there are many codes that do [...] - Reader Questions:
Know the Guidelines for Reporting E/M With CPAP
Question: A patient had a sleep study done and came to our office afterwards. The [...] - Reader Questions:
J8499 Covers Rizatriptan, But Don't Expect Payment
Question: I can’t find a code for the migraine medication Maxalt, aka Rizatriptan Benzoate, as [...] - Reader Questions:
Depend on Payer for Bilateral Reporting Guidance
Question: I need advice on how to code for Medicare versus commercial payers when reporting [...]
