​What is CPT Code 64451? This is for the Block

64451, Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or CT computed tomography), should be reported once for this procedure. The fluoroscopic guidance should not be separately reported as it is included in the work described with code 64451.

• Unilateral (Modifier LT, RT and 50 for Bilateral)
• Imaging is inclusive
• Do not report in conjuction with 64493, 64494, 64495, 77002, 77003, 77012, 95873, 95874
• When performed under Ultrasound, use CPT Code 76999 instead of 64451

Billing for the Genicular Nerve Branches RFA have been a struggle since it was not too clear to us on how we should be billing for this service. The good news is, we have a new code for this effective January 1, 2020. New CPT 2020 Changes. New Pain Management 2020 Codes.
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When your physician is performing an RFA on Genicular nerves, use code 64624 (Destruction by neurolytic agent of genicular nerve branches). Take note of the word "branches".

These changes are explained as follows:
Destruction by Neurolytic Agent (eg, Chemical, Thermal, Electrical or Radiofrequency), Chemodenervation on the Somatic Nerves

CPT CODE 64624 Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed

(Do not report 64624 in conjunction with 64454 - Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed

Pay attention to this, the CPT 64624 requires the destruction of each of the following genicular nerve branches: (make sure your Provider had documented this!)

• superolateral
• superomedial
• inferomedial

If a neurolytic agent for the purposes of destruction is not applied to all of these nerve branches, you can report CPT 64624 but you MUST append the MODIFIER 52:

64624-52

What is Modifier 52?

Modifier 52 is usually used for reduced services. It may occur under certain circumstances that a service or procedure is partially reduced or eliminated at the physician’s discretion. There can be several reasons behind the physician’s decision. In this situation, service provided can be identified by its usual procedure number and the addition of the modifier 52, which indicates that the service was reduced.

Understanding the 3 Genicular Nerve Branches of 64624
Image Source: https://ainsworthinstitute.com/genicular-neurotomy/

What is the CPT code for  Knee Genicular Nerve Branches Block or Injection?​Understanding the 3 Genicular Nerve Branches of 64454
Source: https://ainsworthinstitute.com/genicular-neurotomy/
When your Physician is Blocking the Knee Genicular Nerves - here's your code: (pay attention with the imaging! it is included!).

CPT 64454 - Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches; (make sure your Provider had documented this!)

• superolateral
• superomedial
• inferomedial

If all 3 of these genicular nerve branches are not injected, report 64454 with Modifier;
64454-52

What is Modifier 52?
Modifier 52 is usually used for reduced services. It may occur under certain circumstances that a service or procedure is partially reduced or eliminated at the physician’s discretion. There can be several reasons behind the physician’s decision. In this situation, service provided can be identified by its usual procedure number and the addition of the modifier 52, which indicates that the service was reduced.

Article Source: CPT Assistant December 2019 page 8 Destruction by Neurolytic Agent (Genicular Injection; Radiofrequency Neurotomy Sacroiliac Joint) For Current Procedural Terminology
Got additional questions or concerns? call us today!
Billing Tip: Always make sure you understand and you know the Medical, Clinical, Utilization and Reimbursement Policy of your Payers.
Read other blog posts:HOW TO BILL FOR 20553 WITH 76942 ULTRASOUNDPAIN MANAGEMENT NERVE BLOCKS
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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

Need help? Contact our office today!

​This blog post provides a comprehensive guide on how to correctly bill for MILD (Minimally-Invasive Lumbar Decompression) procedures in the healthcare industry. With clear instructions and helpful tips, the post aims to assist healthcare providers in navigating the billing process, avoiding common errors, and maximizing reimbursements. Whether you are a physician, coder, or biller, this informative post from GoHealthcare Practice Solutions LLC can serve as a valuable resource for billing MILD procedures accurately and efficiently.

Some of my Pain Practice Offices are still confused on how to bill for MILD Procedure. As we all remember, there was no assigned CPT Code for this procedure, we used to report the unlisted code.

In this Blog, I will describe the billing and coding for this procedure using the Vertos Device (www.vertosmed.com

First, let's describe what is MILD? 

MILD stands for MINIMALLY INVASIVE LUMBAR DECOMPRESSION.

Physician Claim:

• Outpatient Hospital (POS 22)
• ASC (POS 24)

CPT Category III Code 0275T is billable when reported as patient participating in a clinical study.

The following information has to appear and included in your claim submission:

• Diagnosis Code (Primary: M48.062 - Spinal Stenosis, lumbar region with neurogenic claudication)
• Diagnosis Code (Secondary: Z00.6 - Encounter for examination for normal comparison and control in clinical research program
• National Clinical Trial (NCT) Number (enter on BOX 19) - 03072927 (number only if submission is by electronic. Enter CT03072927 if by paper submission.
• CPT Category III Modifier - Q0 (** this is the letter Q and the numerical number ZERO, not the letter O).
  

2022 GUIDANCE HOW TO BILL FOR MILD - MINIMALLY INVASIVE LUMBAR DECOMPRESSION BILLING GUIDANCE for the Procedure (NCTØ3Ø72927) - SOURCE VERTOS (SEE ATTACHMENT BELOW)

Video Source is owned by: VERTOS MED - www.vertosmed.com