Neurology & Pain Management Coding Alert

Question: Medicare denied two bilateral Greater occipital nerve injections (64405, Injection, anesthetic agent; greater occipital nerve) claims for being inconsistent with modifier. What is the correct coding?

Texas Subscriber

Answer: Most Medicare contractors want you to report bilateral procedures on a single line item with a single unit of service and modifier 50 (Bilateral procedure) appended. In contrast, for claims processing software to correctly adjudicate the claim, some payers need to have bilateral procedures reported on two line items:

" The first line item with the RT (Right side) modifier appended and one unit of service

" The second line item with the LT (Left side) modifier appended and one unit of service.

Effective Jan. 1, 2008, the Medicare Physician Fee Schedule changed the bilateral status indicator for 64405 to 1 or 150 percent payment adjustment allowed. For earlier dates of service, greater occipital nerve injections could not be reported bilaterally.