Wiki Modifier 59 vs 76 - Pain management

[SarahT89]

Doctor I work for does a lot of RFAs and prior to my time at the practice someone was using -59 for every level after the first and I knew that was wrong for the second code but the 3rd and 4th level I was not sure, the current senior coder now recommends modifier -76 on 3rd and 4th level is appropriate but I've been reading articles saying -59 is appropriate from a few year ago from someone in AAPC. Just for my own clarification after the second level add on, which modifier should be used with levels 3 and 4 with add on codes 64634 and 64636?

Being a new hire out of college I wanted AAPC rules and guidelines on this for 2018 laws and proper modifier usage for my own journey forward.

Thanks!

 

[erinal]

When our docs do a 3 level RFA we will bill 64633 @ 1 unit, and then 64634 @ 2 units. We have not had an issue billing this way. We typically do not bill 4 levels as many times payers won't allow more than 3 levels per area/session. At least in my experience. Hope this helps!