GoHealthcare Consulting Blog on Revenue Cycle Management for Physicians

How to bill for mild - minimally invasive lumbar decompression

7/22/2021

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.

HOW TO BILL FOR MILD - MINIMALLY INVASIVE LUMBAR DECOMPRESSION

HOW TO BILL FOR MILD - MINIMALLY INVASIVE LUMBAR DECOMPRESSION

CPT 0275T is a Category III Code assigned for this procedure.

0275T - Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy, and/or foraminotomy), any method, under indirect image guidance (eg. fluoroscopic, CT), single or multiple levels, unilateral or bilateral; lumbar.

(For percutaneous decompression of the nuleus pulposus of intervertebral disc utilizing needle based technique, use 62287)

So how do you report and bill for this MILD Procedure?

Billing on HCFA 1500 form?

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).

My additional recommendation (especially for Medicare beneficiaries): Enter the "referring physician" on Box 17 the same as the "rendering physician" on Box 24J since the assessment and treatment plan is that from the "Rendering Physician".

Image/Guidance Source: www.vertosmed.com

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

Do you need additional help with billing?

Is it time to negotiate your payers' contract?

6/14/2021

How to Negotiate your Physician Group or Individual Provider's Contract with the Insurance Payers

Revenue Cycle Management Company for Pain Management

Many physician groups or even individual solo practice offices are not happy with their contracted rates or the way they are being reimbursed by the insurance payers? Is it time to negotiate? when is the best time to negotiate your contract?

There is no better time than NOW!

But there are important steps that you need to do before doing so. Negotiating your contract is not only by picking up the phone and calling the insurance payer's provider services department and asking them that you would like to negotiate your contracted fees. Unfortunately, it doesn't work that way!

But there are important steps that you need to do before doing so. Negotiating your contract is not only by picking up the phone and calling the insurance payer's provider services department. It doesn't work that way!

Here are my tips: How to Negotiate your Physician Group or Individual Provider's Contract with the Insurance Payers

First thing first, do you have a copy of your contract? It's very common the Providers would tell me, they have not seen their contracts or they don't have a copy of their contracts. Oh well, it's time to request for a copy of your contract! Call your insurance payer, look for your Area Network Manager or Network Representative. There should be one assigned in your area! Request to get a copy of your contract;
Your contracts should be with accompanied fee schedule or contracted rates. Pay attention to these contracted rates by CPT Code, by Insurance Plan and by Insurance Types!
Review your patients volume and the services you have rendered to the Payer's Members? (past 12-24 months)
Review your EOBs on how are you getting reimbursed, are the fee schedule being followed?
How long have you been contracted with the insurance payer? one year? two years?
How's your current payer's volume? (past 12-24 months)
How's your patients' satisfaction rates? (it helps when you get good reviews from your patients)
How's your patients' outcome? (again, it helps when you get good reviews from your patients)

You need to present your reasoning why you think its time to negotiate your fees!

All of the above, you can present it to the Insurance Payer through the Network Area Manager. Put them all together. Document everything! You can initiate the process by calling, and then by sending a formal letter of intent to renegotiate your contract rates or fee schedule.

Don't forget to involve your billers and coders in this project! Let your patients leave feedback, reviews and about their experience in your practice! All these will surely help get you a better deal.

It's a bit of a process but just be patient and work on it.

Revenue Cycle Management for Pain Management

Do you need help on how to Negotiate your Physician Group or Individual Provider's Contract with the Insurance Payers?

You should contact us today!

How to get paid for genicular knee INJECTIONS

6/14/2021

Understanding the Genicular Nerves (image below)

Prior Authorization for Pain Management

Do you remember the struggle when we didn't have the specific code for the Genicular Nerve Knee Block and for the ablation or the RFA? Prior to January 1, 2020, we used to code them using 64450 for the Peripheral Nerve Block and the you used the 64640 for the Ablation. Not only that, you need to know the nerves that were blocked or were RFA'ed.

But Effective January 1, 2020, we have now a specific code for the Genicular Nerve Knee Block and the Genicular Nerve Knee Ablation. You can read more about that change in our blog. CLICK HERE.

CPT 64454 Genicular Nerve Block
Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed

CPT 64624 Genicular Nerve Ablation or RFA
Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed

Unfortunately many of our Pain and Orthopedic Physicians are still struggling getting reimbursed for these services even though we already have these specific codes in place since 2020. And why is that?

There are common issues why:
1) Their billing staff are still using the old codes CPT 64450, CPT 64640 instead of the CPT Code 64454 and 64624 for the Genicular Nerve Block and Radiofrequency Ablation;
2) What I found is that, this is considered as Investigational and Experimental based on the following guideline when being reported:

Genicular nerve blocks and genicular nerve ablation are considered investigational and not medically necessary for the treatment of chronic knee pain, including but not limited to any of the following:

Degenerative joint disease;
Osteoarthritis of the knee;
As a treatment prior to knee replacement;
As a treatment following knee replacement;
As a treatment for individuals who are not candidates for knee replacement surgery.

But I have also read that there are two CMS Contractors who covers for this procedure based on Medical Necessity. See Group 1 Diagnosis Codes Cross Over:

Group 1 DX Codes:

M25.561 Pain in right knee
M25.562 Pain in left knee

Read more about guidelines:
National Government Services Inc Billing and Coding: Peripheral Nerve Blocks (A57452)
First Coast Service Options, Inc Billing and Coding: Peripheral Nerve Blocks (A57788)

More Guidelines from Payers which consider the procedure to be Investigational:
Aetna Healthcare
Anthem Blue Cross Blue Shield

How do you handle Denial and Appeal for Genicular Nerve Ablation or Genicular Nerve Block?
Here are my tips:
Avoid the denials in the first place! by knowing your payers' guidelines;
If the Provider says its Medically Necessary for the patient to receive the genicular nerve block or genicular nerve ablation, try getting a Predetermination based on Medical Necessity from your Payer! They will not allow you to submit Prior Authorization because for sure, it does not need Prior Authorization because its not a covered benefit based on their policy because the payer considers it "investigational" or "experimental"; Insist on reviewing Predetermination based on Medical Necessity instead!
Already having denied claims? - pursue the claims by sending appeals, get your patient get involved with the appeals process. Be prepared with your medical documentation! How's the Patient's Pain Relief? Duration of Pain Relief? Improved ADL? - include that all in your documentation!
Searched Keywords: GENICULAR NERVE BLOCK DENIAL AND APPEAL CPT BILLING CODE 64454

This is how it looks like when you get paid for Genicular Nerve Knee RFAgenicular-nerve-block-denial-and-appeal.html. Does this not look nice?

How to Get Paid for Genicular RFA Ablation Denial

Example of Genicular Nerve Knee RFA Paid Claim

HOW TO GET PAID FOR GENICULAR NERVE KNEE INJECTIONS

Need help how to Appeal your claims? Contact Us today!
Need help how to obtain Pre-determination before you render the Genicular Nerve Block to your patients? You should contact us today!

NEW CPT 99072 CPT 86413 during covid19 pandemic

9/24/2020

NEW CPT Code 99072 and CPT Code 86413 DURING COVID19 PANDEMIC
These new CPT codes address advancing understanding of COVID-19

NEW CPT 99072 CPT 86413 DURING COVID19 PANDEMIC Gohealthcare Revenue Cycle Management

These 2 new CPT Codes 99072 and 86413 were published on September 8th 2020 and are effective immediately.

NEW CPT 99072 CPT 86413 DURING COVID19 PANDEMIC Gohealthcare Revenue Cycle Management.3

Let's describe these 2 new CPT Codes.

CPT Code 99072     Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease

Take Note:  This new code 99072 is reported only during a PHE (Public Health Emergency) and only for additional items required to support a safe in-person provision of evaluation, treatment, or procedural service(s).

CPT Code 86413     Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative

NEW CPT 99072 CPT 86413 DURING COVID19 PANDEMIC Gohealthcare Revenue Cycle Management.1

According to the AMA:
"The first addition, CPT code 99072, was approved in response to sweeping measures adopted by medical practices and health care organizations to stem the spread of the novel coronavirus (SARS-CoV-2), while safely providing patients with access to high-quality care during in-person interactions with health care professionals. The additional supplies and clinical staff time to perform safety protocols described by code 99072 allow for the provision of evaluation, treatment or procedural services during a public health emergency in a setting where extra precautions are taken to ensure the safety of patients as well as health care professionals. The AMA/Specialty Society RVS Update Committee (RUC) worked with 50 national medical specialty societies and other organizations over the summer to collect data on the costs of maintaining safe medical offices during the public health emergency and submitted recommendations today to the Centers for Medicare and Medicaid Services to inform payment of code 99072."

"The second addition, CPT code 86413, was approved in response to the development of laboratory tests that provide quantitative measurements of SARS-CoV-2 antibodies, as opposed to a qualitative assessment (positive/negative) of SAR-CoV-2 antibodies provided by laboratory tests reported by other CPT codes. By measuring antibodies to SARS-CoV-2, the tests reported by 86413 can investigate a person’s adaptive immune response to the virus and help access the effectiveness of treatments used against the infection."

Must be reported only once per in-person! (read more below)

Code 99072 is to be reported only once per in-person patient encounter per provider identification number (PIN), regardless of the number of services rendered at that encounter. In the instance in which the noted clinical staff activities are performed by a physician or other qualified health care professional (eg, in practice environments without clinical staff or a shortage of available staff), the activity requirements of this code would be considered as having been met; however, the time spent should not be counted in any other time-based visit or service reported during the same encounter.

CPT Guidelines, Q&A from the American Medical Association:

NEW CPT 99072 CPT 86413 DURING COVID19 PANDEMIC Gohealthcare Revenue Cycle Management.3

Understanding PHE or Public Health Emergency in coordination with CPT Code 99072

Question: Code 99072 is stated as being applicable “during a PHE.” What information should be used to verify when a PHE is in effect?
Answer: A PHE is in effect when declared by law by the officially designated relevant public health authority(ies).

Understanding Patient Encounters Type for the determination of CPT Code 99072

Question: For what type of patient encounters or services should code 99072 be reported?
Answer: Code 99072 may be reported with an in-person patient encounter for an office visit or other non-facility service, in which the implemented guidelines related to mitigating the transmission of the respiratory disease for which the PHE was declared are required. Use of this code is not dependent on a specific patient diagnosis. For a list of POS codes with facility/non-facility designations that are available in the Medicare Claims Processing Manual, visit https://www.cms.gov/Medicare/Coding/place-of-service-codes.

Understanding Documentation Requirements when reporting CPT Code 99072

Question: What documentation is required to report code 99072?
Answer: Given that code 99072 may only be reported during a PHE, one would not report this code in conjunction with an evaluation and management (E/M) service or procedure when a PHE is not in effect. Therefore, code 99072 is reported justifiably only when health and safety conditions applicable to a PHE require the type of supplies and additional clinical staff time explained in the code descriptor.
Documentation requirements may vary among third-party payers and insurers; therefore, they should be contacted to determine their specifications.

How about CPT Code 99072 with CPT Code 99070?

Question: May code 99072 be reported with code 99070?
Answer: Yes, code 99072 may be reported with code 99070 when the requirements for both codes have been met. Note that eligibility for payment, as well as coverage policy, is determined by each individual insurer or third-party payer.

Reader's QUESTION - how much are you going to be reimbursed for these 2 new codes?
ANSWER: I have not seen any fee schedule but I suggest you ask your insurance payers and local Medicare Part B contractor.

NEW CPT 99072 CPT 86413 DURING COVID19 PANDEMIC Gohealthcare Revenue Cycle Management.88

Reference sources: https://www.ama-assn.org/press-center/press-releases/ama-announces-new-cpt-codes-covid-19-advancements-expand
https://www.ama-assn.org/system/files/2020-09/cpt-assistant-guide-coronavirus-september-2020.pdf
CPT Assistant September 2020 Special Addition
CPT is a trademark and owned by the American Medical Association.

Modifier for trigger point injection 20553, 20552

9/22/2020

One of our blog readers asked why their claim for Trigger Point injection is being denied due to missing modifier.

MODIFIER FOR TRIGGER POINT INJECTION CPT Code 20553 CPT Code 20552

Let's describe these 2 Trigger point injection codes:
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 muscles

Widely indicated for Myofascial Pain.

Key point to remember! - these 2 CPT Codes 20552, 20553 DO NOT NEED A MODIFIER!

MODIFIER FOR TRIGGER POINT INJECTION CPT Code 20553 CPT Code 20552

Denial Reasons for Trigger Point Injection CPT 20553

Denials Reasons for Trigger Point Injection CPT 20552, 20553 and what you should be looking for:

The lack of medical necessity (have you checked the payer clinical policy and guideline?)
When billing with an E/M Evaluation and Management (you will need a modifier on the E/M but not on the Trigger Point Injection CPT code;
When being performed with another procedure being "distinct" (look at your modifier 59);
When being performed with other "multiple" and or "reduced" procedures (look at your modifier 51, 52);
Missing drug name used;
Missing NDC number for the drug used;

Ask a Question GoHealthcare Prior Authorization Credentialing Services

Need more help? Call us at 732-982-4800 today!

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

Need help? Contact our office today!

CPT 76140 Can PHYSICIAN BILL for X-ray Review?

7/6/2020

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.

Does Medicare Cover Radiofrequency Ablation

7/1/2020

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

Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy

radiofrequency ablation (RFA) of nerves

6/27/2020

How to Document radiofrequency ablation (RFA) of nerves CPT (64635, +64636)

Radiofrequency ablation (RFA), also called radiofrequency neurotomy is an interventional pain management procedure that involves heating a part of a pain-transmitting nerve with a radiofrequency needle to create a heat lesion.

Some of our pain physicians offices are asking the question - How to Document radiofrequency ablation (RFA) of nerves CPT (64635, +64636. What is the proper way of reporting this kind of procedure on the medical record when performed?

Here's a guidance from CPT Assistant Article published on May 2020, quotes:

Question: When performing radiofrequency ablation (RFA) of nerves (64635, 64636), is it necessary that the operative report documents the specific facet joints at which the RFA with imaging occurred as well as the nerves treated or denervated?

Answer: Yes, RFA procedures should clearly state which nerves were ablated and which joints were treated. Codes 64635, Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint, and 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), are reported for each joint treated, not each nerve treated. Stating the specific nerve and the level it innervates eliminates confusion and ensures accurate reporting.

Reference: CPT Assistant Published on May 2020

Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy

U07.2 Covid 19 Virus Not Identified icd-10 coding

6/26/2020

The World Health Organization or the WHO made a code for ICD-10 (not ICD-10-CM) which is the U07.2, COVID-19, virus not identified, intended to give the ability to capture suspected uncertain patients.

The reason you are getting errors in billing this code is that because U07.2 Covid-19, virus not identified
has not been imported into ICD-10-CM (not yet) and its coming up as invalid. It is actually a valid code.

So the guidance is to code the signs and/or symptoms and/or (for example) reporting ICD-10-CM Code Z20.828 - this code is a very code that we can report. Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.

I always suggest that if you have cases where you only see one code such as the U07.2 Covid-19, virus not identified , we need to go back the our providers and let them if they can give you a more appropriate codes based on signs and symptoms and as documented on their medical record.

NEED HELP WITH BILLING AND CODING? CALL OUR OFFICE AT 609-481-3494

HOW TO BILL BILATERAL TRIGGER POINT INJECTION

4/27/2020

Can I Bill for a Bilateral Trigger Point Injection using CPT 20552-20553? The answer is NO. See reasons below:

I know it has always been a challenge on how do we properly bill and code for Trigger Point Injections using 20552 and 20553. Because these codes are being reported based on the number of muscles.

Let's describe these 2 injection codes:

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 muscles

Many are still so confused on how to bill for Trigger Points.

Here are my Coding and Billing Tips:

1. There is NO anatomical modifier; these 2 codes are not unilateral - so modifier 50, LT or RT is not applicable;
2. Code and bill based on the number of muscles (not number of injections!)
3. You can append modifier 59 if it meets the guideline and necessity
4. Possible Imaging Used (may be any of the following):

76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation

77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure)

77021
Magnetic resonance guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation

need help with billing and coding? call our office at 609-481-3494

reader's question: how to bill multiple ekg?

4/27/2020

How to Bill for Multiple EKG Performed by the Same Physician on the Same Day

You can append the Modifier 76 - same service performed on the same day by the same physician. We apply this Modifier on the second line. The first line DO NOT require a modifier. The second line of the same CPT code will be appended with modifier 76.

Need help with Billing and Coding? Call our office at 609-481-3494

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Financial clearance process
Patients Access
Patients Registry and Initial Demographic Entry
Patients Scheduling and Confirming Appointments
Coordination of prior-to-encounter orders management
Prior-to-encounter insurance verification
Obtaining Referral
Obtaining Prior Authorization
Obtaining Peri Operative Orders
Financial Counseling
Insurance Credentialing and Contracting
Payers' Contract Fees Negotiations
Documentation Review
Evaluation and Management Coding Review
Surgical Coding Review
Compliance Program
Office and Surgical Scheduling
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