Wiki 64635/64636

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KDCOWGIRL

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Does anyone know if something has changed with codes 64635/64636. Medicare is now only paying for 1 level of 64636. All the others listed are not being paid and are being called a duplicate, but 64636 says it's for each additional joint. This just recently started happening so I'm wondering if Medicare put a limit of levels they will pay. If not, will putting modifier "59" to indicate an additional level help? Thanks for any help.
 
I've been seeing this, for some reason Medicare is requiring mod 59 for add-on codes, even though they shouldn't based on the code descriptions. The only thing I would check is look up the MUE's on the CMS website and make sure there isn't a limit to the number of levels that would prevent you from billing the way you want. If there is no MUE, or it's high enough to allow your levels, then add modifier 59 to the duplicate add-ons and see if that works.
 
I think the AMA should structure the Radiofrequency codes as the facet codes such as the second code is for the second level and the third code would be for 3 and any additional due to the fact if it is now per joint and the LCD's state more than three levels is not usually covered it would just make the processing more universal.
 
That would be nice. It would also be nice if all reporting and documentation guidelines were standardized across all payers and mandated by federal regs, but when do we think that's going to happen?
 
I had the same issue as well. I called Medicare today and they told me that they were not sure why the subsequent levels were denied. They said they would reprocess it and would let me know in about 30 days.
 
Please tell us what response you get to your appeal. Today I got an EOB back from Medicare since I've started using the "59" and they paid 64635, and 2 levels of 64636 but denied the 3rd level of 64636 as a "duplicate service".
 
That's odd because we've been using mod -59 for the extra levels and having been paid, as far as I know. I'm going to have to remember to look into this on Monday.
 
I have not had any issues to date billing multiple levels for RF to medicare. I bill the extra levels with a 76 and 59 modifier.
 
I called Medicare and finally have a resolution. According to them I need a 76 on the subsequent levels or put the number of them in the units line

Example
64633
64634
64634-76
64634-76

or
64633
64634 3 in the units line
 
And this is why Medicare is such a pain to bill to... I've been told to bill with laterality modifiers and mod -59 for the extra levels. :rolleyes:
 
Incorrect denial

Hello I was going through the same situation with Medicare I bill the additional level with the 76 moidifier. I rcvd full payment then they retracted the second level. I called Medicare as spoke with the supervisor who Name is Candy. Candy sent my complaint to the operations department and the reviewed the information and decided the denial was incorrect and the claim would be reprocessed. I never bill the additional level with the 59 as it is not a separate procedure it is the same procedure just and additional level. Use the 76 on the additional lines. I hope this helped, maybe we need to contact the insurance commissioner and advise them of what medicare is doing as it is not warranted.

Thanks
La'Voncye, CPC, :)
 
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