Genicular coding

[emd123]

My billing/coding people are telling me that a three nerve genicular block can only be billed as a single nerve block, 64450, one unit. This seems like you should be able to bill 3 units or use -51 modifier, and get paid for 3 nerves

Which is it?

And, can you use 77002 or is that gone from all nerve blocks now?


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[BobBarker]

Definitely x3
I think I am still getting 77002 as well but I haven't been doing very many lately. Like one a quarter.

 

[Ducttape]

recent meeting of state pain society stated you can only bill for 1 genicular nerve block and 1 RFA. can still use 77002.

 

[lobelsteve]

At this time all states and all Insurance have no uniform policy.

 

[emd123]

Okay, thanks guys. What about the RFA?

64999?

64999 X 3?


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[Ligament]

It is three seperate nerves....

 

[unchockey21]

We had been billing for 3. As of last month, our biller said it's down to one now.

 

[Ligament]

Why the change? Who determined these three nerve injections count as one??

 

[Ducttape]

same people who decided that we bill by facets rather than median branches??

 

[ziggyziggy]

I had the same discussion with biller and Peer to peer. I was told the same that it should be billed as 1 level because the 3 genicular branches are part of 1 nerve. But if we follow that, it means every nerve comes from 1 brain and therefore should be 1 level. Which means everything is 1 in a person. They laughed at it but I was paid x3.

 

[lobelsteve]

Genicular are branches of femoral x2 and sciatic x1.

 

[drusso]

Genicular are branches of femoral x2 and sciatic x1.

Steve, how do you bill the hip?

 

[lobelsteve]

2 nerves.
Femoral and obturator articular branches.

 

[painfree23]

This is the dumbest thing I've heard. Pain is getting so ridiculous. Who makes these stupid decisions?? When a plumber fixes 3 pipes are ur house do u tell him, no sorry that was actually just one pipe and a continuation of it, so I'm gonna only pay ya for 1..take it or leave it. Ugh! So frustrating.

 

[bedrock]

Ridiculous. Another reason to just code the diagnostic blocks as a sciatic block and a femoral nerve block as I've proposed earlier, particularly if they are trying to not pay for all 3 nerves or the fluoro code now.
Would recommend just doing genicular RFA for cash only.

We deserve to get paid for our time and expertise.

 

[geauxg8rs]

This is the dumbest thing I've heard. Pain is getting so ridiculous. Who makes these stupid decisions?? When a plumber fixes 3 pipes are ur house do u tell him, no sorry that was actually just one pipe and a continuation of it, so I'm gonna only pay ya for 1..take it or leave it. Ugh! So frustrating.

And he charged extra since your pipe burst after hours or on a weekend.
And he gets to have a cool van
not a bad gig

 

[Ducttape]

well, according to this coder I talked to...

it is one knee...

 

[NJPAIN]

Ridiculous. Another reason to just code the diagnostic blocks as a sciatic block and a femoral nerve block as I've proposed earlier, particularly if they are trying to not pay for all 3 nerves or the fluoro code now.
Would recommend just doing genicular RFA for cash only.

We deserve to get paid for our time and expertise.

Have you been coding the diagnostic blocks that way?

I'm assuming the cash recommendation is for non-Medicare or can you make the case that it is a non-covered benefit and get a signed ABN?




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[pastafan]

I could see some twisted logic allowing coding as 2 nerves but branches off sciatic and femoral should not be reduced to 1 nerve. We are not getting paid by Medicare or UHC for 77002 with diagnostic blocks or RFA.

Is this one nerve decision being challenged by any of the national organizations?

 

[Taus]

I recently spoke to rep about this. They rec'd putting a 59 modifier on 64450 after the first one. Said it's getting paid...


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[cbest]

Did three cooled RF cases last week. Rep recommended I bill...
64450
64450-59
64450-59
77002-26

Also, the genicular nerve blocks X3 I did before the RF got paid when I documented as "genicular nerve block of superomedial branch of vastus medialis, superolateral branch of vastus lateralis, and inferimedial branch of saphenous" rather than just "genicular nerve blocks."

I recently spoke to rep about this. They rec'd putting a 59 modifier on 64450 after the first one. Said it's getting paid...


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[paindoc007]

Okay, thanks guys. What about the RFA?

64999?

64999 X 3?


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What’s 64999? Should be 64640x3 for rfa

 

[MD87]

Any updates on this, for both blocks and RFA? A coolief rep told me a few months ago that blocks are typically only getting paid 1 nerve but RF gets paid for 3. This makes absolutely no sense to me... but is it true? Want to know what I'm getting myself into before offering these to patients. For the record, I won't have access to coolief, but that was my source of info.

 

[Pain_doc]

this was from a Halyard brochure, dated 2016:

When billing Medicare use the following approach in coding: RF Lesion of superior lateral geniculate: 64640
RF Lesion of superior medial geniculate: 64640-76
RF Lesion of inferior medial geniculate: 64640-76

I'm in WPS territory and they don't seem to pay for the blocks or the RF presently.

 

[Jcm800]

can someone update me on this. so what is the consensus? for the block and the RFA? one 64450 and NO 77002 is pretty weak for the amount of work it requires.

 

[Timeoutofmind]

My coders told me:

Flouro bundled for both

Block is x1
RFA is x3

 

[Orin]

2017 update from NCCI
"""
8. CPT codes 64400-64530 describe injection of anesthetic agent for diagnostic or therapeutic purposes, the codes being distinguished from one another by the named nerve and whether a single or continuous infusion by catheter is utilized. All injections into the nerve including branches described (named) by the code descriptor at a single patient encounter constitute a single unit of service(UOS). For example:
(1) If a physician injects an anesthetic agent into multiple areas around the sciatic nerve at a single patient encounter, only one UOS of CPT code 64445 (injection, anesthetic agent; sciatic nerve, single) may be reported.
(2) If a physician injects the superior medial and lateral branches and inferior medial branches of the left genicular nerve, only one UOS of CPT code 64450 (Injection, anesthetic agent; other peripheral nerve or branch) may be reported regardless of the number of injections needed to block this nerve and its branches.
"""

 

[DODOCSS]

ditto

 

[soccrwz]

One nerve, as all nerve blocks regardless of different anatomic location come from the spinal cord dontcha know...

What insurances are you getting this covered for, mine seem to reject this all the time?

 

[lobelsteve]

One nerve, as all nerve blocks regardless of different anatomic location come from the spinal cord dontcha know...

What insurances are you getting this covered for, mine seem to reject this all the time?

Try not using M codes. Just the G code for icd10.