Wiki 62311 with 64483??

[BFAITHFUL]

doc did a caudal epidural steriod injection and a right L4-L5 transforaminal epidural injectionl patient's diagnosis is herniated disc herniation at L4-L5, T12-T1 L1-L2 and radiculopathy at L4-L5. Im not sure if I should code both and use modifier 59 with 64483?

 

[rkmcoder]

(These are my opinions and should not be construed as being the final authority. Other opinions may vary.)

You should always (with few exceptions) code everything that your physician does, and follow NCCI edits for modifiers.

Richard Mann, your pain management coder
rkmcoder@yahoo.com

 

[dwaldman]

If the intralaminar and transforaminal epidurals are done at the same level the 59 modifier would not be appropriate because the 59 would be denoting separate anatomical location or separate patient encounter. Since it looks like the transforaminal was done at L4-5 and then a epidural using the caudal approach would be considered separate levels so I believe that the 59 on the 64483 would be appropriate in this particular situation.

 

[BFAITHFUL]

thank you..... so then if I'm understanding this correctly , because of different approaches is the reason why I can use modifier 59, even let's say, if its to treat the same condition?

 

[dwaldman]

Two different levels two different approaches seems that would met the criteria to bill 64483 59 62311.

https://www.cms.gov/MLNMattersArticles/downloads/SE0715.pdf

This article stresses separate site or separate encounter. My interpretation is that the procedure are at separate sites and the two injections would provide separate effects after adminstration even if for the same goal.

 

[BFAITHFUL]

thank you