Neurology & Pain Management Coding Alert

Question: When billing for multilevel lumbar facet joint nerve radiofrequency, (i.e., L2, L3, L4 and L5), 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: If all the levels were on the same side, rather than submit as four single line items, you could instead 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 -RT x 3 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' claims processing software can't process multiple units; others have certain ways to submit multiple add-on levels, i.e. request providers use modifier 76 (Repeat Procedure or Service by Same Physician or Other Health Care Professional) rather than modifier 59 (Distinct Procedural Service); still others may limit the number of levels the physician can radiofrequency ablate during a single session. Likewise some payers' software might not recognize more than one modifier, which means you may need to indicate that a total of four levels were treated in box 19 or the electronic equivalent. Because of these types of variances, check with the payer for their specific guidelines to determine the best way to submit the claim.