Part B Insider (Multispecialty) Coding Alert
Stick With Correct Code, Even if Non-covered
Question: Our payer included codes 64470-64476 on the 2009 physician fee schedule, but dropped them in 2010 as non-covered services. The latest schedule also does not include new codes 64490-64495. I have enough documentation to determine an acceptable E/M service level. Can I report and E/M code instead of the facet injection so our provider gets paid something? Answer:
Coding guidelines direct you to code the service your physician provided and documented, whether you expect payment or not. Choose the appropriate code from 64490-64495 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT]...) and submit to your carrier. Appeal any denials and exhaust all reimbursement efforts before adjusting the service and writing off the fee.
Check related codes:
Confirm whether the fee schedule includes 64622-64627 (Destruction by neurolytic agent, paravertebral facet joint nerve ...). Physicians often perform a facet block as a precursor to determine whether radiofrequency ablation of the facet joint nerves would be a suitable treatment option. If the carrier covers 64622-64627, you could begin the process of lobbying for coverage of 64490-64495.Communicate:
Talk with your physicians and the staff member who handles precertification about the denials, so everyone knows the situation. Education helps everyone share correct information with your patients before the procedure. The patient and physician might discuss alternative treatments, or the patient might agree to pay for the procedure himself.Part B Insider (Multispecialty) Coding Alert
- CPT 2011:
CPT 2011 to Debut Codes for Hip Arthroscopy, Subsequent Observation Care
Check out this sneak peek to get a glimpse of the codes you'll be using [...] - E/M Coding:
Knock Out Questions on New/Established Patient E/M
Remember, what used to be a consultation is now likely a CPT 99201 [...] - Part B Mythbuster:
Overcome Medically-Unlikely Edit Denial Challenges by Busting 4 Myths
If you ignore the medically unlikely edits, you're asking for a denial.If you're receiving denials [...] - Reader Questions:
Look for Causes Before Coding Sleep Apnea
Question: What ICD-9 code should I report when the physician performs a level-two E/M on [...] - Reader Questions:
Bilateral Done On 1 Side Means 52
Question: A patient underwent a hysteroscopy. The code 58565 represents a bilateral procedure, but in [...] - Reader Questions:
'Diagnostic' and 'Therapeutic' Defined
Question:Can you explain the difference between "diagnostic" and "therapeutic" injections or nerve blocks? How does [...] - Reader Questions:
Stick With Correct Code, Even if Non-covered
Question:Our payer included codes 64470-64476 on the 2009 physician fee schedule, but dropped them in [...] - Reader Questions:
'Joint Fracture' Is a Misnomer
Question: Which diagnosis code should I use for an SI joint fracture?Answer: When looking at [...] - Physician Notes:
CMS Offers Tool to Determine When Medicare is Secondary
Plus: OIG blasts suppliers' modifier KX claims.When a patient has no other insurance coverage besides [...]
