I thought 64520 for lumbar sympathetic blocks? But I could see how it could also apply to ganglion impar...
Which part of the lumbar is the tailbone
I bill it as a small joint for that extra $7 😉
You’re in fellowship right? The hospital billers routinely “fix” things after the fact so the procedures get paid
That makes sense. I'll see if I can find out what it ultimately got billed as.
If you would like to get paid for this procedure, I would suggest billing small joint 20600 (or medium), plus fluoro code 77003. I often stick on “other peripheral nerve” 64450 with a 59 modifier, but not sure if last part gets paid. I only do a handful of these per year, but getting paid for the above is better than a zero (or technically a loss with your overhead and opportunity cost for a spine injection slot) imo.
Reimbursement for 64999 is typically $0
Can you explain the use of a 59 modifier with 64450 in this case? Or when 59 is commonly used in pain in general? I'm reading about it and I see that you use it to decouple payments that are normally grouped together, though I'm not fully understanding when/why that's used.
High risk of what? Rectal puncture if you go way too deep?
I don’t pretend to be an expert on this. My understanding is that it’s for a “separately identifiable procedure“, i.e., you are doing two different procedures. I learned this years ago when billing blocks and Rfa for sij. Billed the L5-S1 facet code and then 59 modifier for “peripheral nerve”, 3 units, for the lateral branches. That was until it got its own code… Which was subsequently killed off by the insurers, similar to genicular.
Id like some clarification on this as well. i had only been using the -59 modifier when i am also billing an e/m. for example, if i am seeing a new patient and i do a GTB and gluteus medius tendon injection for example. i never thought about using it when i do 2 procedures at once (like say an SIJ and GTB) under flouro when i dont typically bill an e/m
E&M plus procedure is a 25 modifier.
what about e/m plus 2 procedures? with each being separately identifiable? that is 25 AND 59, correct?
Yes. Although at that point the payor is probably going to find a way to screw you over. I know for us, Blue Cross won’t cover a 25 modifier if you’ve seen the patient for the same diagnosis in the last 90 days. So if the patient comes back to review imaging, and is also wanting a TPI done so that they can have something right away, Blue Cross is going to deny the 99214 for reviewing the imaging and ordering a procedure, and only pay for the TPI.
Is puncturing the rectum not considered high risk? "way too deep" is a major overstatement in my opinion. Yes it is unlikely, but you're talking a matter of a a couple mm.
Seems like a different ordinance of magnitude of risk compared to sticking the spinal cord on a CESI
He still around? I remember he was into coccydynia 20 years ago. Called himself the tailbone guy or something like that.
