Anyone do hardware injections? What do you bill?

[drrosenrosen]

I don't do them often, but sometimes, it seems that pedicle screws or Harrington rods are really what's generating the pain. I follow the "anesthetize what hurts" diagnostic plan and just inject some marcaine right where it hurts. I've never been sure what to code for these injections. I imagine that there might be some shredded remnants of medial branch nerve living there somewhere near the screws, but since I do them in the office I certainly don't bill MBB. Does anybody else inject on hardware? What do you code for it?

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[Ligament]

I generally bill for peripheral nerve blocks

 

[bedrock]

so 64450?

 

[Mister Mxyzptlk]

It seems as though the depth varies. Sometimes I think there is a damaged MB in there someplace. Other times infiltrating around the more superficial hardware works. I'm not sure there's only one type of problem with hardware. I think some PLLS could be neuropathic from damaged MBs (CRPS II?) and some is from the soft tissues around the nuts and bolts.

 

[PinchandBurn]

It seems as though the depth varies. Sometimes I think there is a damaged MB in there someplace. Other times infiltrating around the more superficial hardware works. I'm not sure there's only one type of problem with hardware. I think some PLLS could be neuropathic from damaged MBs (CRPS II?) and some is from the soft tissues around the nuts and bolts.

are you coding that as CRPS2?

lol


I was wondering this question as well. IF you do it under fluro, couldnt you still bill this as a paravertebral facet injection (aka mbb)? As someone indicated, its likely there is still some of those mbbs that are still there. On the flip side, I know you can not bill to RF that particular facet, since you can not bill for an RFA at a level of fusion ......

Other peripheral nerve also seems interesting......and I gues you could bill fluro code w/ that as well...I'm assuming you are using fluro/ultrasound.

 

[PMR 4 MSK]

Somewhere in the CPT advisor booklets, they said 64999 for hardware injection. I believe I've always gotten it paid, it just takes months.

 

[PinchandBurn]

when one of hte SCS reps was sort of putting down one of the spine surgeons he stated: "Dr X will send you a whole bunch of hardware blocks. YOu know you dont get paid for that right?"

So.....I dont know what to believe...If you bill as 64999

 

[miamidoc2b]

bumping this - any updates on how to bill for a hardware block correctly?

 

[emd123]

Trigger point + fluoro?

 

[Crybaby]

Our office seems to get a lot of referrals for them. I hear of a few insurance companies saying they do not pay.

We code 64999 and fluoro - we get a few denials from insurance

 

[bedrock]

TPI + fluoro seems reasonable and likely to get paid.

 

[clubdeac]

marvel hammer said you have to bill a 64999 in a workshop I attended a few years back

 

[bedrock]

marvel hammer said you have to bill a 64999 in a workshop I attended a few years back

Sorry, but my response to that is .....whatever

I don't bill 64999 for anything because you almost never get paid for that code. If I "have" to use 64999 for a procedure then it automatically becomes a cash pay procedure. I don't work for free if I can help it.


TPI + fluoro is reasonable given what you are doing and certain to be paid.

 

[ampaphb]

Sorry, but my response to that is .....whatever

I don't bill 64999 for anything because you almost never get paid for that code. If I "have" to use 64999 for a procedure then it automatically becomes a cash pay procedure. I don't work for free if I can help it.


TPI + fluoro is reasonable given what you are doing and certain to be paid.

May be 'reasonable', but also is fraud. Your target is not the trigger point, it's the hardware.

 

[lobelsteve]

May be 'reasonable', but also is fraud. Your target is not the trigger point, it's the hardware.

But if I do not save images I never took images and cannot bill for them. Does that make for a trigger point?