Reader questions:
Payer might want more specific diagnosis
Published on Mon Nov 23, 2009
Question: I billed facet and epidural steroid injection codes 64475 and +64476 with fluoroscopic guidance. I included the modifier 50 because it was a bilateral procedure, and diagnosis 724.5 (Backache, unspecified). Why did Medicare deny the claim? Tennessee Subscriber Answer: The denial might be because you reported an "unspecified" diagnosis for the procedure; reimbursement for these claims can be difficult because you're telling the payer that you don't know much about the patient's problem. Try reporting a more specific diagnosis, such as 724.2 (Lumbago) or 721.3 (Lumbosacral spondylosis without myelopathy). The rest of your claim should be correct, assuming you're coding for a lumbar or sacral level injection: • 64475 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, single level) with modifier 50 (Bilateral procedure) • +64476 (... lumbar or sacral, each additional level [List separately in addition to code for primary procedure]) [...]
