billing rfa

[Yo GabbaPentin]

How have you all been billing rfa? I have been using 64635 x1 and 64636 x2 for a four needle lumbar rfa. My billing people keep adding a 59 modifier for the 64636. Is that right?

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[jsaul]

How have you all been billing rfa? I have been using 64635 x1 and 64636 x2 for a four needle lumbar rfa. My billing people keep adding a 59 modifier for the 64636. Is that right?

I think they are telling you wrong. It is not a separate distinct procedure you are doing.

Just bill 64635 and 64636

 

[bedrock]

How have you all been billing rfa? I have been using 64635 x1 and 64636 x2 for a four needle lumbar rfa. My billing people keep adding a 59 modifier for the 64636. Is that right?

They are wrong. The 64636 is part of the same procedure.

You would only use the. 59 modifier to clarify a completely separate procedure, like a knee injection performed the same day.

 

[emd123]

How have you all been billing rfa? I have been using 64635 x1 and 64636 x2 for a four needle lumbar rfa.

Same as this. No modifier.

 

[Yo GabbaPentin]

Thanks. That's what I thought. Maybe it's the reason I've received denials on 6 rfas! Because our super smart biller went ahead and made that addition of the modifier on their own.

 

[mid|ine]

Your biller is wrong

 

[Pain Applicant1]

It's important to find out why the biller went ahead and used modifier 59. I'm guessing because it was getting denied. Denied without 59, denied with 59...what should you do? Nix 59 for the reasons mentioned above and try modifier 76.

 

[Yo GabbaPentin]

Nope. It's because our billing doesn't know what they are doing. I submitted the charge 64636 X 2 and they kept asking if I was SURE that was right. I said yes and they subsequently used 59 mod for 6 more RFAS where 4 needles were used.

 

[Pain Applicant1]

I found Medicare to deny me with 64636 x2. Let me know how that works out. Also, are you billing 64636 with 2 units or 64636 on two separate lines.

 

[Yo GabbaPentin]

Two units, not two separate lines. It has to be on two separate lines?

 

[emd123]

I found Medicare to deny me with 64636 x2. Let me know how that works out. Also, are you billing 64636 with 2 units or 64636 on two separate lines.

2 units
No denials so far

 

[bedrock]

2 units
No denials so far

same here

 

[Pain Applicant1]

Two units, not two separate lines. It has to be on two separate lines?

I guess not. I was getting denied and I tried to figure out why. What I found is that modifier 76 should work. I resubmitted and am waiting to see how that works out. I'll start trying using 2 units from here on out.

 

[SSdoc33]

It's important to find out why the biller went ahead and used modifier 59. I'm guessing because it was getting denied. Denied without 59, denied with 59...what should you do? Nix 59 for the reasons mentioned above and try modifier 76.

mod 76?

ive never even thought about using mod. 76. anybody else use it?

 

[bedrock]

mod 76?

ive never even thought about using mod. 76. anybody else use it?

I Never use mod 76

 

[Pacman27]

So not sure if this is right but there are some docs billing
64635 x 1
64636 x3

For L3/4, L4/5, and L5/S1 but because its 4 nerves they are billing for 4 nerves

Thoughts

This is per the medicare lcd, it does state median branch and states 5 levels. Hard to make sense out of it when they allow only 3 levels for the diagnostic injections

It is not expected that paravertebral facet joint destructions (median branch) will exceed five (5) levels, unilaterally or bilaterally on the same date of service.

 

[SSdoc33]

So not sure if this is right but there are some docs billing
64635 x 1
64636 x3

For L3/4, L4/5, and L5/S1 but because its 4 nerves they are billing for 4 nerves

Thoughts

This is per the medicare lcd, it does state median branch and states 5 levels. Hard to make sense out of it when they allow only 3 levels for the diagnostic injections

It is not expected that paravertebral facet joint destructions (median branch) will exceed five (5) levels, unilaterally or bilaterally on the same date of service.

you added one extra 64636. you would have to burn L1,2,3,4, and L5 dorsal ramus to bill the way you did above. that would cover L2-3, L3-4, L4-5, and L5-S1.

I admit that I do sometimes do a 3 joint RF bilaterally, but rarely a 4 joint RF. in the ancient spines it can make sense sometimes

 

[emd123]

You can bill one less level than # of rf needles. 4 needles/nerves, bill 3 rf levels/joints. Changed in 2012. Whether or not people are billing the extra nerve and getting away with it is a different question.

 

[freddydpt]

I thought 59 modifiers aren't used anymore and its the new X{EPSU} system. Anyone care to clarify?

 

[Stim4me]

Also try using L vs R modifiers for some insurance plans as well as mod 76 as mentioned above... Really every insurance has quirks...

 

[bkpa2med]

How have you all been billing rfa? I have been using 64635 x1 and 64636 x2 for a four needle lumbar rfa. My billing people keep adding a 59 modifier for the 64636. Is that right?

So, courtesy of Furmans graphics, if you are performing a 4 needle RFA I assume you are ablating the L2, L3, L4 and L5 MB correct? Would that be 64635 and 64636 x 3 ?

 

[emd123]

No. It is 64635 + 2 units of 64636. 4 nerves to treat 3 joints. You're treating 3 joints, by ablating the nerve above and below. Coding changed from billing by nerve, to billing by joint in 2012.

 

[clubdeac]

I never use modifier -59 when billing my RF's. Should I be?