Orthopedic Coding Alert

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.

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.