Orthopedic Coding Alert

The latest CCI edits aren't the only April 1 change affecting you Reimbursement for many bilateral injections is twice as nice -- or close to it -- under the April Medicare physician fee schedule. The scoop: Medicare changed the bilateral status indicator for many peripheral nerve injection codes to "1," meaning Medicare will pay for bilateral injections, says Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, principal of MJH Consulting in Denver. Medicare pays 100 percent of the allowable for the first procedure and 50 percent for the second with modifier 50. Previously these codes had a "0" status indicator, which meant that if you reported the code with modifier 50 (Bilateral procedure) or with RT (Right side) and LT (Left side), Medicare would pay for only a single injection, Hammer says. Watch out: These changes apply to Medicare, but other payers may not update their fee schedules until 2009, Hammer says. Check All 2008 Claims for These Codes Affected codes include those in the peripheral nerve range: 64400-64410, 64413-64417 and 64421-64449. All of these codes- descriptors begin with "Injection, anesthetic agent." Example: If the orthopedic surgeon performs bilateral femoral nerve blocks, you should report 64447 (Injection, anesthetic agent; femoral nerve, single) with the appropriate modifier. Depending on your payer, you may report 64447-50; 64447 and 64447-50; or 64447-LT and 64447-RT. Good news: The change went into effect April 1, but it's retroactive to Jan. 1. Resource: You can find the transmittal online, Hammer says: http://www.cms.hhs.gov/transmittals/downloads/R1482CP.pdf.