Wiki 64450 Injection with ULS guidance

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Blyewskiconger

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Hello, I work in an orthopedic clinic and we have an MD who has recently started providing carpal / cubital / ulnar tunnel injections under ultrasound guidance. For billing we thought the best path for cubital tunnel specifically would be 64450 with 76942 with a diagnosis of G56.22. When we did this we got a front end rejection from our system due to an LCD issue reported here (https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57589&ver=16) and we changed our ICD to M79.2 as neuritis was also listed in dictation. We are STILL getting a rejection and found some evidence that 64450 and 76942 cannot be billed together?

Can someone confirm if this is correct and if so, is there a more comprehensive code that would cover this sort of injection or is the guidance indicated within the 64450?

Thank you in advance for any assistance!
 
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That LCD does not apply to cubital tunnel, carpal tunnel or guyon's canal - these are specific, compressive, mononeuropathies. That LCD concerns when it is inappropriate to bill for injections for peripheral neuropathy, which is a completely separate set of diagnoses. The LCD should not be interpreted as saying that those secondary codes cannot be coded with 64450 - that is true only in the case of subcutaneous injections for peripheral neuropathy.
G56.2x would be the appropriate diagnostic code set for cubital tunnel syndrome, and CPT specifies that 64450 does NOT include image guidance, so 76942 is the correct code to use.
There is no NCCI edit between the two.

TL;DR:
You are coding correctly, and your system is rejecting the code pair inappropriately because of misinterpretation of the LCD.
N
 
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NRaizman said:
That LCD does not apply to cubital tunnel, carpal tunnel or guyon's canal - these are specific, compressive, mononeuropathies. That LCD concerns when it is inappropriate to bill for injections for peripheral neuropathy, which is a completely separate set of diagnoses. The LCD should not be interpreted as saying that those secondary codes cannot be coded with 64450 - that is true only in the case of subcutaneous injections for peripheral neuropathy.
G56.2x would be the appropriate diagnostic code set for cubital tunnel syndrome, and CPT specifies that 64450 does NOT include image guidance, so 76942 is the correct code to use.
There is no NCCI edit between the two.

TL;DR:
You are coding correctly, and your system is rejecting the code pair inappropriately because of misinterpretation of the LCD.
N
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Thank you very much for your explanation! That really helps and clears things up and will help us fix our internal system that is pinging as incorrect.
 
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Agree with Dr. Raizman. You have to bypass your system edit and get it fixed. If the provider is brand new to your group, I would make sure everything is being documented correctly and scrutinize the procedure reports to make sure everyone is on the same page.

Checking to make sure, you are using 20526 for carpal?

Also, make sure the ultrasound guidance documentation is up to snuff. https://www.kzanow.com/coding-coach...t=Question:,the ultrasound must be maintained.
Helpful link: https://www.aapmr.org/members-publications/newsroom/member-news/2017/05/30/may-coding-q-a (older date but helpful)

Hello from Munising :)
 
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