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Wiki Pain Management codes
- Thread starter KELLI
- Start date
trose45116
Expert
what insurance are you billing. i use RT AND LT when i code for these. i dont have any problems
ASc Bilateral
I agree with Trose
While there may be a few payers who recognize 50 for ASC, most have to see 2 lines with Lt Rt modifiers in order to pay correctly.
If you've been consistently using modifier 50 for all payers- including Medicare, I would recommend that you have someone audit the payments. Most payers do not pay 150% of the allowable unless they see the code 2x. Their ASC payment platforms do not recognize the modifier 50 You may only be receiving 100% of the allowable for the procedure instead of 150%.
I audited a facility and found that they had been receiving 100% for over 3 years but because the amount matched the fee schedule they did not catch onto the fact that they should have been paid 150% of the fee, not 100.
Melanie
I agree with Trose
While there may be a few payers who recognize 50 for ASC, most have to see 2 lines with Lt Rt modifiers in order to pay correctly.
If you've been consistently using modifier 50 for all payers- including Medicare, I would recommend that you have someone audit the payments. Most payers do not pay 150% of the allowable unless they see the code 2x. Their ASC payment platforms do not recognize the modifier 50 You may only be receiving 100% of the allowable for the procedure instead of 150%.
I audited a facility and found that they had been receiving 100% for over 3 years but because the amount matched the fee schedule they did not catch onto the fact that they should have been paid 150% of the fee, not 100.
Melanie
mendezdenise
Guest
- Messages
- 2
- Best answers
- 0
One of our doctors did a sacrococcyxgeal ligament injection and they want us to bill with 20550. I suggested 62311 since this injection was in the lower spine. Any comments or suggestions?
Thanks,
Denise M
Thanks,
Denise M
delphinus777
Networker
mendezdenise:
In my opinion, I would not use the 62311 for the ligament injection. The procedure description for 62311 states "The solution is injected into the epidural or subarachnoid space", whereas 20550 description states "The physician injects a therapeutic agent into a single tendon sheath, or ligament, aponeurosis such as the plantar fascia in 20550 and into a single tendon origin/insertion site in 20551........The needle is inserted and the medicine is injected......"
Again, just my opinion.
In my opinion, I would not use the 62311 for the ligament injection. The procedure description for 62311 states "The solution is injected into the epidural or subarachnoid space", whereas 20550 description states "The physician injects a therapeutic agent into a single tendon sheath, or ligament, aponeurosis such as the plantar fascia in 20550 and into a single tendon origin/insertion site in 20551........The needle is inserted and the medicine is injected......"
Again, just my opinion.