Wiki 20550 & 64450

[kmleland]

My doc is billing 20550 & 64450 together and I keep getting a CO-97 denial on 64450. It is not being billed for plantar fasciitis but instead a forearm nerve injury. I can't find a clear answer on why the 64450 is denying. Can anyone advise?

 

[TThivierge]

Hi
Are the CPTs listed and dx code linked properly? Have you added modifier 59 or XS on 2nd CPT code since differ areas he is treating? He is treating the heel CPT 20550 and arm CPT 64415 be better. But if this is for injection in heel use CPt code 64455 ..The denial code is CO 97 is saying can t do these 2 treatments together unless add modifier. Goggling says ....Denial claim - CO 97 - CO 97 Payment adjusted because this procedure/service is not paid separately. If appropriate, resubmit your claim after appending a modifier. Also add LT or RT per limb has condition too.
I hope this data helps you
Lady T

 

[carolinemccravy]

My doc is billing 20550 & 64450 together and I keep getting a CO-97 denial on 64450. It is not being billed for plantar fasciitis but instead a forearm nerve injury. I can't find a clear answer on why the 64450 is denying. Can anyone advise?

The injection in the heel code you have listed is correct. Do not use 64455, that is for a digital injection. As far as the 64450, that is for other peripheral nerve so that code appears to be correct. Some plans like Medicare will not accept that code for anything, even tarsal tunnel dx. If it were me, I would add 59 on the 64450 and then any other mod for indicated the extremity. The denial you are getting is due to bundling, but they are different anatomical areas. Try the 64450 first with mod 59, then lt or rt. If it denies again, then appeal with notes. It shouldnt. What insurance is it?

 

[kmleland]

The injection in the heel code you have listed is correct. Do not use 64455, that is for a digital injection. As far as the 64450, that is for other peripheral nerve so that code appears to be correct. Some plans like Medicare will not accept that code for anything, even tarsal tunnel dx. If it were me, I would add 59 on the 64450 and then any other mod for indicated the extremity. The denial you are getting is due to bundling, but they are different anatomical areas. Try the 64450 first with mod 59, then lt or rt. If it denies again, then appeal with notes. It shouldnt. What insurance is it?

Good Afternoon,
Thank you for your response. BCBS is the biggest culprit but I have seen the same with UHC. I will try the 59 modifier on the 64450 and go from there. Thanks so much! Have a great evening!