Wiki pain management-I billed medicare

[ranna1]

I billed medicare 64445 with a diagnoses 724.4 L/S radiculopathy and 20610 large joint with a diagnoses 726.60 knee bursits with the modifer 59. the 20610 was rejected as a bundled procedure.



any inpute would be greatly appreciated

 

[johnmeyer]

Most pain managment codes in the 60000s are actually bundeled into the other injection codes (20600, 20605, 20610, etc).

If you look at 64445, the definition includes injection.

Hope this helps.

 

[mitchellde]

Instead of appending the 59 mod to the joint injection, you could try adding the 25 mod to the nerve block

you cannot add a 25 to a procedure code it is for use with E&M only.
you should appeal as it appears you had everything correct, just check the dx code linkage and be certain you had only the radiculopathy code linked to the 64445 and the knee only linked to the 20610.

 

[Jennifer Moore]

I work for a pain management provider, per the CCI edits the 59 modifier has to be on the 64445 code. I would only use the specific ICD-9 codes for the specific CPT codes. Hope this helps.


Jennifer Moore, CPC