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CPT CODE FOR SACROILIAC SI RFA FOR 2020 CPT 64625

7/26/2020

January 1, 2020 - we now have a new Pain Management Code CPT 64625 - SI Ablation

Description of CPT Code 64625

Radiofrequency ablation, nerves innervating the sacroiliac joint, with imaging guidance (Fluoroscopic or Computed Tomography).

Keypoints to REMEMBER!

Do not report 64625 in conjunction with 64635, 77002, 77003, 77012, 95873, 95874
For radiofrequency ablation, nerves innervating the sacroiliac joint, with ultrasound, use 76999
For Bilateral procedure, append 50 Modifier with 64625

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Patient Access Management and Revenue Cycle

7/9/2020

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The Patients Access plays a very important role in capturing and collection of patient service revenue.

PATIENT ACCESS MANAGEMENT AND REVENUE CYCLE

Patients Access and a Successful Revenue Cycle Management
The Patients Access plays a very important role in capturing and collection of patient service revenue.

There are 3 parts of Revenue Cycle where the Patient Access Management is very important and the Patient Access Team plays a very valuable role.

1. Pre-service Phase

Scheduling patients
Pre-registering patients
Verifying insurance coverage and eligibility
Verifying pre-certification and referral requirement
Discussing patient costs and providing financial counseling services if required

2. Time of Service

Activate the patients record in the Electronic Medical Record and or Practice Management system
Attached copy of insurance card front and back on the patient's chart
Attached copy of government issued identifications on the patient's chart
Patient reviews and sign the consent forms
Completed the positive patient identification
Financial Clearance
Patient Arrival
Patient Care Delivery

3. Post-service Phase

Claims Submission
Patients Responsibility
Claims follow up

Focusing on Customer Service and Patient Satisfaction is very important.

Customer Service and Patient Satisfaction
1. Treating patient with respect and dignity
2. Treating patient as you would want to be treated
3. Communicating in a manner the patient can easily understand
4. Value your patient's time and focus on efficiency
5. Show empathy to your patient

What pieces of information do we gather:

Patient's Name
Address
Date of Birth
Primary Insured's name (Subscriber)
Social Security number (Guarantor/Subscriber)
The insurance company name
The patient's insurance ID and group number
Photo ID
Copy of the primary and secondary insurance card (front and back)
Subscriber's relation to the patient (self, spouse, child, other)

Additional Useful information that you can also gather from the patient:

Patient's complaints (pain? injury?)
Patient's Primary Care Physician (if applicable)
Date of Accident? (for Liability Insurance such as Motor Vehicle and Workers Compensation)
State where the Accident happened
Name of the Injury Attorney (if available)
Name of Injury Case Adjuster (if available)
Name of Injury Nurse Manager (if available)

So what's next after obtaining all the necessary information?
1. Patient access team member must start confirming coverage for the patient
2. Verify if the provider is in-network or out-of-network with the patient's plan
3. Check eligibility if the patient is eligible for coverage on the date of service
4. Ask the patient if they have a secondary insurance coverage
5. Complete clarifying the benefits for services with the insurance company
6. Check the patient's copayment or any co-responsibility and if the patient has an out of pocket amount that has to be met (family or individual
7. You can ask the insurance company for specific benefits for specific services. I always suggest giving insurance company specific CPT code(s) or Diagnosis code(s) if available - document everything
8. Collect the copay at the time of service if you are contracted with the patient's insurance plan;
9. Verify if there is a deductible or coinsurance and how much have been met, you can collect them at the time of service as well
10. Make sure you be knowledgeable enough on how to answer the patient about their concern and questions about their copay or any other co-responsibility.

Let's look at how the Patient Access team verifies patient who has a Medicaid Coverage:
Viewing a patient's ID card alone does not ensure their Medicaid eligibility, nor does having a referral or pre-certification on file. As a member of the Patient Access team, insurance can be verified during pre-service or on the date of service.

It is imperative in my opinion that the Patient Access team must verify eligibility during the MONTH that patient is scheduled to be seen or is coming for service. Because their coverage may always change. If you fail to verify eligibility, there is a very high risk of claim denial for sure. Possible scenarios? the patient may not be eligible at the time of service, or the HMO was not contracted with your practice at that time of service. Result? claim may not get paid. Resulting in lose of revenue.

PATIENT ACCESS Patient Satisfaction and Patient Quality Care

What happens if we did not correctly verify the patient identity?

Medical error including the wrong medication, not knowing about their allergies and or the patient's blood type etc
Claims denial resulting to non-payment for services from the insurer
Poor patients outcome
Poor patients experience since they will receive a bill for the entire cost of the rendered services

About 40% of data used for revenue cycle management are gathered by Patients Access Teams.

About 40% of data used for revenue cycle management are gathered by Patients Access Teams. Mistakes and errors will greatly affect the billing and coding process thus causing payments delay. Delayed reimbursement will significantly affect your cash flow.

Patients satisfaction, prompt payments are the best results of your high quality customer service and are all based on how good your team with their communication skills.

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CPT 76140 Can PHYSICIAN BILL for X-ray Review?

7/6/2020

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Let's decribe this code: CPT 76140 Consultation on x-ray examination made elsewhere, written report. (2D reformatting is no longer separately reported. To report 3D rendering, see 76376, 76377)

CPT 76140 CAN PHYSICIAN BILL FOR X-RAY REVIEW

So the question is, can a Provider bill for X-ray review using CPT Code 76140?

Sharing to you coding clarification here. (Source are from CPT Assistant as published by the AMA). CPT is a trademark and owned by the American Medical Association.

Continue reading by scrolling down

CPT Assistant October 1997
Using CPT Code 76140
76140 Consultation on x-ray examination made elsewhere, written report. You would use this code when a physician's opinion or advice regarding a specific film is requested by another physician and upon examination of the film, the consulting physician renders his or her consultation (ie, or his/her opinion or advice) to the requesting physician in the form of a written report.

If a patient presents to an office for a new patient visit and brings to the physician his or her medical records, including x-rays, you should not report code 76140. Although the x-rays may have been taken elsewhere, the physician does not perform a consultation as intended by code 76140. Rather, the review or re-read of the x-rays would be considered part of the face-to-face E/M service provided to the patient. Again, the E/M codes include work done before, during, or after the E/M visit. Review of x-rays is part of the E/M service. Remember, 76140 represents a consultation, in which a physician only renders an opinion or gives advice regarding the film in the form of a written report. In general, when reporting 76140, the physician is not concurrently providing an E/M face-to-face service to the patient.

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CPT CODE 20552, 20553 Trigger Point iNJECTIONS

7/2/2020

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CPT CODE 20552, 20553 TRIGGER POINT INJECTIONS. Medicare guideline.

CPT Codes and Description

20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)
20553 Injection(s); single or multiple trigger point(s), 3 or more muscle(s)

Understanding Trigger Point Injection
Trigger point injection is one of many modalities utilized in the management of chronic pain. Myofascial trigger points are self-sustaining hyperirritative foci that may occur in any skeletal muscle in response to strain produced by acute or chronic overload. These trigger points produce a referred pain pattern characteristic for that individual muscle. Each pattern becomes part of a single muscle myofascial pain syndrome (MPS) and each of these single muscle syndromes are responsive to appropriate treatment, which includes injection therapy. An injection is achieved with the insertion of a needle and the administration of agents, such as local anesthetics, steroids and/or local inflammatory drugs.

The diagnosis of trigger points requires a detailed history and thorough physical examination. The following clinical symptoms may be present when making the diagnosis:

History of onset of the painful condition and its presumed cause (e.g., injury or sprain)
Distribution pattern of pain consistent with the referral pattern of trigger points
Range of motion restriction
Muscular deconditioning in the affected area
Focal tenderness of a trigger point
Palpable taut band of muscle in which trigger point is located
Local taut response to snapping palpation
Reproduction of referred pain pattern upon stimulation of trigger point

The goal is to treat the cause of the pain and not just the symptom of pain.

Limitations
Acupuncture is not a covered service, even if provided for the treatment of an established trigger point. Use of acupuncture needles and/or the passage of electrical current through these needles is not covered (whether an acupuncturist or other provider renders the service).
Medicare does not cover Prolotherapy. Its billing under the trigger point injection code is a misrepresentation of the actual service rendered.
When a given site is injected, it will be considered one injection service, regardless of the number of injections administered.

Utilization Guidelines
It is expected that trigger point injections would not usually be performed more often than three sessions in a three month period. If trigger point injections are performed more than three sessions in a three month period, the reason for repeated performance and the substances injected should be evident in the medical record and available to the Contractor upon request.

This contractor may request records when it is apparent that patients are requiring a significant number of injections to manage their pain.

Documentation in the medical record must support the medical necessity and frequency of the trigger point injection(s).

20552, 20553 DX Crossover based on Medical Necessity

M53.82 Other specified dorsopathies, cervical region
M54.2 Cervicalgia
M54.5 Low back pain
M54.6 Pain in thoracic spine
M60.80 Other myositis, unspecified site
M60.811 Other myositis, right shoulder
M60.812 Other myositis, left shoulder
M60.819 Other myositis, unspecified shoulder
M60.821 Other myositis, right upper arm
M60.822 Other myositis, left upper arm
M60.829 Other myositis, unspecified upper arm
M60.831 Other myositis, right forearm
M60.832 Other myositis, left forearm
M60.839 Other myositis, unspecified forearm
M60.841 Other myositis, right hand
M60.842 Other myositis, left hand
M60.849 Other myositis, unspecified hand
M60.851 Other myositis, right thigh
M60.852 Other myositis, left thigh
M60.859 Other myositis, unspecified thigh
M60.861 Other myositis, right lower leg
M60.862 Other myositis, left lower leg
M60.869 Other myositis, unspecified lower leg
M60.871 Other myositis, right ankle and foot
M60.872 Other myositis, left ankle and foot
M60.879 Other myositis, unspecified ankle and foot
M60.88 Other myositis, other site
M60.89 Other myositis, multiple sites
M60.9 Myositis, unspecified
M75.80 Other shoulder lesions, unspecified shoulder
M75.81 Other shoulder lesions, right shoulder
M75.82 Other shoulder lesions, left shoulder
M79.11 Myalgia of mastication muscle
M79.12 Myalgia of auxiliary muscles, head and neck
M79.18 Myalgia, other site
M79.7 Fibromyalgia

Take-away! Remember that these codes CPT 20552, 20553 are NOT billable as unilateral. Modifier 50 (bilateral) will NOT apply. Bill by the number of muscles!

POLICY SOURCE: NOVITAS PART B LCD L35010 TRIGGER POINT INJECTIONS

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Does Medicare Cover Radiofrequency Ablation

7/1/2020

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READER'S QUESTION: Does Medicare Cover Radiofrequency Ablation for Pain Management in New York?

Here's the Coverage Information from Medicare Part B

Indications:

Patient must have history of at least 3 months of moderate to severe pain with functional impairment and pain is inadequately responsive to conservative care such as NSAIDs, acetaminophen, physical therapy (as tolerated).
Pain is predominantly axial and, with the possible exception of facet joint cysts, not associated with radiculopathy or neurogenic claudication.
There is no non-facet pathology that could explain the source of the patient’s pain, such as fracture, tumor, infection, or significant deformity.
Clinical assessment implicates the facet joint as the putative source of pain.

General Procedure Requirements:

Pre-procedural documentation must include a complete initial evaluation including history and an appropriately focused musculoskeletal and neurological physical examination. There should be a summary of pertinent diagnostic tests or procedures justifying the possible presence of facet joint pain.
A procedure note must be legible and include sufficient detail to allow reconstruction of the procedure. Required elements of the note include a description of the techniques employed, nerves injected and sites(s) of injections, drugs and doses with volumes and concentrations as well as pre and post-procedural pain assessments. With RF neurotomy, electrode position, cannula size, lesion parameters, and electrical stimulation parameters and findings must be specified and documented.
Facet joint interventions (diagnostic and/or therapeutic) must be performed under fluoroscopic or computed tomographic (CT) guidance. Facet joint interventions performed under ultrasound guidance will not be reimbursed.
A hard (plain radiograph with conventional film or specialized paper) or digital copy image or images which adequately document the needle position and contrast medium flow (excluding RF ablations and those cases in which using contrast is contra-indicated, such as patients with documented contrast allergies), must be retained and submitted if requested.
In order to maintain target specificity, total IA injection volume must not exceed 1.0 mL per cervical joint or 2 mL per lumbar joint, including contrast. Larger volumes may be used only when performing a purposeful facet cyst rupture in the lumbar spine.
Total MBB anesthetic volume shall be limited to a maximum of 0.5 mL per MB nerve for diagnostic purposes and 2ml for therapeutic. For a third occipital nerve block, up to 1.0 mL is allowed for diagnostic and 2ml for therapeutic purposes.
In total, no more than 100 mg of triamcinolone or methylprednisolone or 15 mg of betamethasone or dexamethasone or equivalents shall be injected during any single injection session.
Both diagnostic and therapeutic IA facet joint injections and medial branch blocks (see criteria below) may be acceptably performed without steroids.

Diagnostic Facet Joint Injections

Dual MBBs (a series of two MBBs) are necessary to diagnose facet pain due to the unacceptably high false positive rate of single MBB injections.
- A second confirmatory MBB is allowed if documentation indicates the first MBB produced > 80% relief of primary (index) pain and duration of relief is consistent with the agent employed.
Intraarticular facet block will not be reimbursed as a diagnostic test unless medial branch blocks cannot be performed due to specific documented anatomic restrictions.

Therapeutic Injections

Either intraarticular injections or medial branch blocks may provide temporary or long-lasting or permanent relief of facet-mediated pain. Injections may be repeated if the first injection results in significant pain relief (>50%) for at least 3 months. (See Limitations section for total number of injections that may be performed in one year.)
Recurrent pain at the site of previously treated facet joint may be treated without additional diagnostic blocks if >50% pain relief from the previous block(s) lasted at least 3 months.

Thermal Medial Branch Radiofrequency Neurotomy (includes RF and microwave technologies):

Only when dual MBBs provide > 80% relief of the primary or index pain and duration of relief is consistent with the agent employed may facet joint denervation with RF medial branch neurotomy be considered
Repeat denervation procedures involving the same joint will only be considered medically necessary if the patient experienced > 50% improvement of pain and improvement in patient specific ADLs documented for at least 6 months.

Limitations of Coverage:
A maximum of five (5) facet joint injection sessions inclusive of medial branch blocks, intraarticular injections, facet cyst rupture and RF ablations may be performed per year in the cervical/thoracic spine and five (5) in the lumbar spine.

For each covered spinal region (cervical/thoracic or lumbar), no more than two (2) thermal RF sessions will be reimbursed in any calendar year, involving no more than four (4) joints per session, e.g., two (2) bilateral levels or four (4) unilateral levels.
Neither conscious sedation nor Monitored Anesthesia Care (MAC) is routinely necessary for intraarticular facet joint injections or medial branch blocks and are not routinely reimbursable. Individual consideration may be given for payment in rare unique circumstances if the medical necessity of sedation is unequivocal and clearly documented.
Non-thermal RF modalities for facet joint denervation including chemical, low grade thermal energy (<80 degrees Celsius), as well as pulsed RF are not covered.
Intraarticular and/or extraarticular facet joint prolotherapy is not covered.

Let's describe the CPT codes 64633-64636

CPT CODE 64633 DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); CERVICAL OR THORACIC, SINGLE FACET JOINT
CPT CODE +64634 DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); CERVICAL OR THORACIC, EACH ADDITIONAL FACET JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

CPT CODE 64635 DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, SINGLE FACET JOINT
CPT CODE +64636 DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, EACH ADDITIONAL FACET JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Related Billing Articles

Source reference: LCD ID L35936 Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy NGS Medicare Part B
National Government Services, Inc. MAC - Part A 06101 - MAC A J - 06 Illinois
National Government Services, Inc. MAC - Part B 06102 - MAC B J - 06 Illinois
National Government Services, Inc. MAC - Part A 06201 - MAC A J - 06 Minnesota
National Government Services, Inc. MAC - Part B 06202 - MAC B J - 06 Minnesota
National Government Services, Inc. MAC - Part A 06301 - MAC A J - 06 Wisconsin
National Government Services, Inc. MAC - Part B 06302 - MAC B J - 06 Wisconsin
National Government Services, Inc. A and B and HHH MAC 13101 - MAC A J - K Connecticut
National Government Services, Inc. A and B and HHH MAC 13102 - MAC B J - K Connecticut
National Government Services, Inc. A and B and HHH MAC 13201 - MAC A J - K New York - Entire State
National Government Services, Inc. A and B and HHH MAC 13202 - MAC B J - K New York - Downstate
National Government Services, Inc. A and B and HHH MAC 13282 - MAC B J - K New York - Upstate
National Government Services, Inc. A and B and HHH MAC 13292 - MAC B J - K New York - Queens
National Government Services, Inc. A and B and HHH MAC 14111 - MAC A J - K Maine
National Government Services, Inc. A and B and HHH MAC 14112 - MAC B J - K Maine
National Government Services, Inc. A and B and HHH MAC 14211 - MAC A J - K Massachusetts
National Government Services, Inc. A and B and HHH MAC 14212 - MAC B J - K Massachusetts
National Government Services, Inc. A and B and HHH MAC 14311 - MAC A J - K New Hampshire
National Government Services, Inc. A and B and HHH MAC 14312 - MAC B J - K New Hampshire
National Government Services, Inc. A and B and HHH MAC 14411 - MAC A J - K Rhode Island
National Government Services, Inc. A and B and HHH MAC 14412 - MAC B J - K Rhode Island
National Government Services, Inc. A and B and HHH MAC 14511 - MAC A J - K Vermont
National Government Services, Inc. A and B and HHH MAC 14512 - MAC B J - K Vermont

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Blog Posts

CPT CODE FOR SACROILIAC SI RFA FOR 2020 CPT 64625

Need help? Contact our office today!

Patient Access Management and Revenue Cycle

Need help with Patient Access Management?

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CPT 76140 Can PHYSICIAN BILL for X-ray Review?

CPT CODE 20552, 20553 Trigger Point iNJECTIONS

20552, 20553 DX Crossover based on Medical Necessity

Does Medicare Cover Radiofrequency Ablation

Here's the Coverage Information from Medicare Part B

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