Wiki Rhizotomy Procedures

[SueCode3988]

We always do our Rhizotomy procedures in 2 sessions. The left side then the right side. The first session is getting paid fine it is the 2nd session that is getting rejected by Medicare Plus Blue and also Priority Health. I have billed just RT or LT on the 2nd session, I have also billed modifier 79 (global period) along with the RT or LT and I have also billed just the modifier 79. My rejections from them are either "in a global period" if I bill just the RT/LT or "missing procedure modifier" if I bill just the 79 but no RT/LT. Any help would be greatly apprecited with this. I do have authorizations that I am attaching so that is not the issue, it seems to be with what modifiers they want. We are in Michigan. Thank you. Sue Johnson
example: 64635 79
64635 79 RT
64635 RT
None are getting paid.

 

[TThivierge]

Hi SueCode
Per the Medicare A56670 learning data on this topic it states to bill either CPT 64635 with modifier 50 defining both sides. Or if patient treating in a AMB facility bill 64635 and 64636 with LT and RT modifiers on each claim line. Use CPT 64635 lumbar area and CPT 64636 each additional joint. Billing 64635 RT and 64635 LT is wrong.
Check CPT manual cause CPT for neck area is 64634 and or 64633. Id leave off modifier 79
I hope helped you somewhat
Lady T