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!
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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)  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. 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. READER'S QUESTION: Does Medicare Cover Radiofrequency Ablation for Pain Management in New York? Here's the Coverage Information from Medicare Part BIndications:
General Procedure Requirements:
 Diagnostic Facet Joint Injections
Therapeutic Injections
Thermal Medial Branch Radiofrequency Neurotomy (includes RF and microwave technologies):
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.
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) 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 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 NEED MORE HELP? Call our office at (609) 481-3494 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.  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:
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 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.  |
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Ms. Pinky Maniri-Pescasio is the Founder of GoHealthcare Consulting. She is a National Speaker on Practice Reimbursement and a Physician Advocate. She has served the Medical Practice Industry for more than 25 years as a Professional Consultant. search hereArchives
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