Wiki Help with modifiers!

[abrodskycpc]

Hi all,

My doctor did 4 levels of RFA. So the codes would be:

64635x 1 and 64636 x 3

How would you code this?

Would you do:

64635-LT
63636-LT
64636-59-LT (2 units)

or something else?

Much appreciated!

 

[Walker22]

From a strictly AMA coding perspective, 64635x1, 64636x3 seems to be the best choice. Payers, however, have some different ideas about the way the want codes and modifiers listed on the claims, so you may want to investigate that further with them.

 

[marvelh]

I would double check about the four levels of RFA, that would mean your provider did ablation of at least 5 separate nerves. This is not impossible but not as likely as RF ablation of three facet joints (4 nerves)

Since the new codes were created in 2012, the coding is based on the facet joint, not each individual nerve.