genicular nerve block coding

[smarterchild]

hi guys. i'm having some issues getting coverage of genicular nerve blocks and RF. I bill 64450 x 1 for the block and 64640 for the RF. Medicare recently denied a claim, stating it is not a medical necessity based on my local coverage determination.

Have you guys encountered this before and, if so, how did you end up dealing with it? thanks!

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[No Pain All gain]

What diagnosis code are you using?


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[smarterchild]

thanks for the reply. currently, i've used m17.11 (osteoarthritis of the knee) and z96.651 (that is for presence of knee arthroplasty). is there another code i should be using?

thanks!!

 

[No Pain All gain]

Typically use right knee pain or mononeuropathy of lower extremity in post-tka patients if saphenous neuralgia present.


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[callmeanesthesia]

thanks for the reply. currently, i've used m17.11 (osteoarthritis of the knee) and z96.651 (that is for presence of knee arthroplasty). is there another code i should be using?

thanks!!

Yes, use the code for knee pain. Check your LCD that applies and it will list acceptable ICD 10 codes to justify medical necessity. Of course, this will all be a moot point in 3 weeks when the new genicular code takes over.

Does anyone have info yet on what will be required in terms of diagnostic blocks and other medical necessity requirements with the new codes?

 

[smarterchild]

thank you all! I will try to resubmit it.

 

[lobelsteve]

Never use code for OA knee.

 

[smarterchild]

Thank you Steve! I changed the codes as you all recommended. Hopefully it works. Thanks again for the advice!

 

[Multimodal]

anyone having issues getting the new genicular block/RFA codes ? I just got a kaiser/medicare one denied. tricare in the northwest also just notified us that that it is now investigational where it was covered without issue up to earlier this year. I feel like all the insurances are going to start making the genicular block/RFA investigational since its a new code. any thoughts ?

 

[buddababa]

anyone having issues getting the new genicular block/RFA codes ? I just got a kaiser/medicare one denied. tricare in the northwest also just notified us that that it is now investigational where it was covered without issue up to earlier this year. I feel like all the insurances are going to start making the genicular block/RFA investigational since its a new code. any thoughts ?

basically every insurance is denying it. Some even the diagnostic block. Including Medicare replacement plans. Getting very frustrating

 

[smarterchild]

Yes, I’m having the same problems. So far, I have only been reimbursed by Medicare. I All of the other ones have rejected it. I’m starting to offer it to some patients at a cost, which, of course, they are refusing.

 

[Multimodal]

I am hopeful that it's just a hiccup since the codes are new but am going to be pissed if they just up and got rid of genicular block/RF. I think once medicare has an LCD with this on there, we can use that to fight these denials. If I could have proven that yesterday on a P2P call with Kaiser, I would have gotten it approved. none of my patients are going to want to pay for this OOP sadly.