Wiki Bilateral Coding

[tsraccntg@gmail.com]

I am receiving denials from UHC for bilateral Cervical Facet Joint Nerve Block. According to them, we need to be coding it the following way in order to received appropriate reimbursement:

Assume B/L, 2 levels (just the injection portion)

64490
64490-50
64491
64491-50

Is this correct?

Thanks!

T

 

[capricew]

Each payer has a contract with you that should clarify how they want your bilateral procedures billed. This may be how your particular contract is structured for bilateral billing. The problem is that on facet injections, if you did a third level, you are only allowed to bill 64492 or 64495 once per day per CPT guidelines. You may want to look at your contract and verify how they want you to bill. If this is how your contract reads, then you want to make sure your physician is aware of this and perhaps not do bilateral facets on the same day.

Hope this helps!

Caprice Walder, CPC