Neurosurgery Coding Alert

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]) with modifier 50

• 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve, or sacroiliac joint], including neurolytic agent destruction) with modifier 26 (Professional component).