And then here is a question that we didn’t get to last time. This was on the forum and she was asking, Ana, about… they’re getting denials for 64495–LT-59. And she’s got the you know, whole op report here… and all of these codes. So basically, what 64495 is injections, diagnostic or therapeutic agent of paravertebral facet joints with image guidance, etc. So what we need to figure out is when you… the facet joint is on either side of the spine so it’s bilateral. So let me just take you to my answer sheet I prepped.
64495-LT and 64495–LT-59 Video
And so she was saying these are all the codes that they bill. But this one because they have 64495 on the left side twice was getting denied. So to do a little bit of research, I went to Find-A-Code in this case and they have that plain English description which I love. And here is where they talked about paravertebral facet joints also called zygapophyseal joints are located on the back of the spine on each side of the vertebra, at the point where one vertebra overlaps the next. So that kind of gives you an understanding, anatomy-wise of what’s going on.
So with that in hand, doing a little Google searching around, came across on CMS, guidance that we should use modifier 50 in that case. And here’s the link for that which again, was going to be in the resource handout. It’s a PDF and this is from the Medicare Learning Network. It’s a little old but it still applies. And it says “provider action needed”. Let me make this a little bit bigger if I can, there we go. It says, “This article clarifies the appropriate use of modifier 50, not 59 and add on codes for facet joint injection services. Physicians who perform facet joint injections on both the right and left sides of one level of the spine must use modifier 50 with the appropriate CPT codes when submitting claims.” It goes on to say that if a physician performs it on multiple levels on the same side then they have to use the add on codes to represent the additional levels injected instead of using modifier 50. So this is just a way to kind of be your own consultant. I’m going to do a slide on that in a little bit. But that’s how you would figure that out. So needing to use those add on codes or modifier 50 depending on the situation.
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