Wiki ASC Facility billing for Facet Injections

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missyah20

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Good Afternoon,
I do the professional billing for a CRNA in WA who provides facet injections in an ASC. We bill the facet injections with the 64490 - 64495 codes. The ACS has been billing these codes as well and their charges have been getting denied. Can someome please clarify for me how the ASC should be billing for these charges? Should the facility be billing codes 64490 - 64495 as well for their charges?

I do not know much about how the facility side works.

Thanks so much!
 
missyah20 said:
Good Afternoon,
I do the professional billing for a CRNA in WA who provides facet injections in an ASC. We bill the facet injections with the 64490 - 64495 codes. The ACS has been billing these codes as well and their charges have been getting denied. Can someome please clarify for me how the ASC should be billing for these charges? Should the facility be billing codes 64490 - 64495 as well for their charges?

I do not know much about how the facility side works.

Thanks so much!
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Hi there-
We always used the same CPT codes on both sides (professional and facility), so I don't think that would be the problem. My concern is we billed MD's doing these procedures-not CRNAs. Could it be out of their scope of practice or something to do with the payer? :confused:
 
No I don't think so, per the Noridian article CRNA Practice and Chronic Pain Management codes within the 64400 - 64530 range are payable (these are Medicare claims they are having denied). They also have an MDA on staff who will perform these injections when the CRNA is on vacation or not available and the facility charge is being denied for those as well.

The facility sent us one of their redetermination letters and on that acct it appeared that they denied for medical necessity. Our, CRNA charge denied for that as well - so that really didn't help me.

Do you think it could be the diagnosis coding on the facility side? Most of these patient's do present with conditions that are supported per the records and that support medical necessity per the Medicare LCD, but if they were not in the proper order it could cause this denial chain. It just seems weird to me that all of their facet charges would be denying.
 
It might also be that the ASC isnt allowed to do these svcs as a contract with payor perhaps for these services? Might look into that as a possibility too.
 
We doing ASC billing for facet injections and get paid by Medicare. We use modifer SG. I don't know if that might be your problem or not but I went back and checked after your post and I don't see anything out of the ordinary that's done other than you didn't mention the SG.
 
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