Orthopedic Coding Alert
Modifier 52-Injection Claim Getting Denied? Try This Instead
Question: Our providers commonly perform lumbar sympathetic plexus blocks via single injection, which we code with 64449. Because the code descriptor says continuous infusion by catheter, not single injection, we’ve tried appending modifier 52 to 64449 to show reduced services, but Medicare is denying the whole charge and won’t pay separately. Do you have any suggestions? Maryland Subscriber Answer: The single lumbar plexus injection has been an issue for many years, and there are various recommendations for how to report it. While some have suggested reporting it as you have indicated, this is causing denials. Try this: Since the procedure is a single lumbar injection, consider 64520 (Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic)). This is supported by a clinical policy bulletin (CPB) 0863 published by Aetna, indicating this as the correct code for a single lumbar sympathetic plexus block. When there is not an existing code that applies to the procedure performed, the typical rule is to report an unlisted code, for example, 64999 (Unlisted procedure, nervous system), with thorough documentation that includes an explanation of the services provided.
Related Articles
Orthopedic Coding Alert
- ICD-10 2024:
Update Adds to Osteoporosis Dx Options
Desmoid tumor? There’s a code for that in 2024. Summertime is known for cookouts, pool [...] - Shoulder Surgery:
Scope Reason for Procedure to Use These Codes Correctly
Some require debridement; others call for surgery past debridement. When a patient reports to the [...] - Clip And Save:
Remember to Include These Services in Shoulder Scopes
The global surgical package for these surgeries is large. When the orthopedist performs an arthroscopic [...] - AI Learning:
Use CPT® Appendix S to Aid AI Understanding
Appendix S sheds light on AI nuances. The CPT® code book always contains an overwhelming [...] - You Be the Coder:
Multiple Finger Fractures
Question: Encounter notes indicate the orthopedist performed two surgeries: closed treatment of a proximal phalanx [...] - Reader Questions:
Modifier 52-Injection Claim Getting Denied? Try This Instead
Question: Our providers commonly perform lumbar sympathetic plexus blocks via single injection, which we code [...] - Reader Questions:
Use Dx Code Trio for This Laminectomy Patient
Question: A new patient presents with cervical spinal stenosis at C5-C6 and degenerative disc disease [...] - Reader Questions:
I.D. Anatomical Site for Compression Syndrome
Question: Encounter notes indicate that a patient suffers from anterior spinal artery compression syndrome. How [...]
