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    Attempted TFESI with LESI

    According to the note, my provider attempted a TFESI @ level L4-L5 but because of the anatomy and previous surgeries it was impossible to proceed, so the procedure was switched to an LESI @ levels L5-S1. My question is can I bill for the TFES (CPT 64483) as discontinued with modifier -53? There...
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    Wiki ITP Catheter Revision

    Quick question - so my provider when he does an IPT pump replacement, he has been noting he's also doing a catheter revision. His note is: " I noted the catheter portion that connected the pump to the catheter is not well maintained so we decided to remove this portion. There was free flow of...
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    Wiki Cosentyx - J3490 Wasted medications

    One of my providers has started using Cosentyx and is billing with J3490. However, there is a wasted medications and I've never billed for wasted medications with J3490 (unlisted). Does anyone have any directions for billing units and $$$ amounts? Thank you
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    Wiki MBB T11-T12, T12-L1

    Hello all - just need a little verification on this level for coding. The provider is performing an MBB @ T11-T12, T12-L1. I believe the correct code set would be: 64490, 64491. Any input would be greatly appreciated. Thank you
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    Wiki Injection for Bertolotti's Syndrome

    I'm looking the CPT code for an injection for Bertolotti's syndrome. The procedure is documented: "The area was prepped with chlorhexidine in the regular sterile fashion technique. Local anesthetic administration using a 25 G needle then We used an image intensifier to locate the joint between...
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    Wiki MBB Injection

    The provider performed an MBB at levels T12-L1, L1-L2. Per the coding guidelines T12-L1 should be coded as 64490... I know he's doing the injection for the lumbar nerves and I have coders saying it should be 64493-64494. Please provide some clarification on this ongoing issue. TIA
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    Wiki Botox injections for Migraines

    I'm looking for a little input... I have always billed 64615 for botox injections for chronic migraines. Our office is asking me, since another provider bills 64612, 64616 for the injections for migraines. Below is a copy of the procedure note. I know the 64615 was created more specifically for...
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    Wiki Facet Joint Injections LCD Policy Question

    My provider has started documenting for a 2nd diagnostic MBB injection and according to the LCD policy - "The KX modifier should be appended to the line for all diagnostic injections. In most cases the KX modifier will only be used for the two initial diagnostic injections. If the initial...
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    Wiki Intrathecal Pain Pump Refill Medication

    Hello - I need some help in getting some information to provide to get our pain pump medication refills paid. We have received recoupment requests from insurance stating that Non-FDA approved drugs were used. According to our billing department, they want us to bill each drug individually with...
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    Wiki SCS Generator Replacement w/new pocket created

    The doctor I code for did a SCS generator replacement with a new pocket and I want to make sure I'm coding it correctly. It looks like there is now a CCI edit for CPT 63685, 63688. Previously, we have coded for the new pocket with 64999. The report reads: The electrodes were then connected and...
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    Wiki Spinal Cord Stimulator Electrodes Implant - Anthem denial

    I have been recently been receiving denials from Anthem denials on the SCS Electrodes implants. We bill CPT 63650 x2 (the doctor is placing 2 leads). We get an authorization for 2 leads and they keep denying the 2nd lead. As far as I've seen, the coding hasn't changed as this shouldn't require a...
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    Wiki Medicare denial Benlysta

    We have been getting denials from Medicare for this drug, HCPCS code J0490 - as not covered when self administered. The office manager keeps insisting on adding modifier -JA to the code to get it paid. I don't see that it qualifies for this modifier as this is given intravenously and not...
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    Wiki Pain Pump Refill Question

    We have a patient the doctor did a catheter patent test and aspirated all the medication out of the pain and performed a refill with the same medication that was aspirated and removed from the pump. Since he's refilling with the same medication that was withdrawn from the pump, this wouldn't...
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    Wiki RFA LCD Updated policy

    I have a question on the updated LCD policy for the RFA's. If the provider does a bilateral on 1 level, will he be able to have the patient come back within the 12 month period to have another bilateral for the level performed?
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    Wiki MBB at Thoracic & Lumbar region

    The provider is performing an MBB @ T10 -T11 & T11-T12 to block T11-T12 & T12-L1. T12-L1 is considered lumbar region, so would I bill 64490, 64493 or should this be billed as all thoracic, 64490, 64491? Thank you for any input.
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    Wiki Peripheral Stimulator switched to Spinal Cord Stimulator

    I have a patient the doctor placed a peripheral stimulator previously and is not switching to a spinal cord stimulator. The generator from the old stimulator was removed & a new pocket was created for the new spinal stimulator generator. He placed 2 new leads and also routed and connected the...
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    Wiki Bupivacaine for office procedures

    The provider I code for has begun doing some injections in the office. He's using Bupivacaine for the injections. No other meds are used for the injections (such as Depo-Medrol). An example is: 0.50 mg Bupivacaine. What would be the best way to bill this? I know C9290 is for the ASC and the...
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    Wiki Medicare Denials

    I have a quick question.... I am getting Medicare denials for CPT 96365, that it's not billed with an appropriate code. We do not bill for "J" code as the patient receives the medications free from the foundation. They have been appealed with denial upheld. Any information on this would be...
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    Wiki Plantar fascia injection under U/S Guidance

    The provider I code for performed this procedure on a patient snip of note below: The area over the medial malleolus was cleaned with chlorhexidine in a sterile fashion. We then used ultrasound guidance in order to identify the medial malleolus, as well as the left plantar fascia...
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    Wiki J3490/J7999

    I have a quick question on billing compound drugs for pain pump refills: Our system requires an NDC # to be entered, What NDC # should I use from invoice from the pharmacy? This is an example of an invoice we get from the pharmacy for our pain pump refills. I bill as follows: J3490/J7999...
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    Wiki Modifer -53???

    My provider was to perform a Vertiflex on a patient in the ASC - Anesthesia started giving the patient Mac & IV sedation and the patient became unresponsive & stopped breathing. My provider assisted in ventilating the patient, after the patient awoke, the provider decided to cancel the...
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    Wiki Duplicate NDC denials

    Hello - I just recently starting coding for Rheumatology. We have a drug - Acterma; CPT J3262 that we bill with 2 different NDC #'s and units. An example is: we use 600 units and bill as 1 line with 400 units with appropriate NDC # and the 2nd line would be billed with 200 units with the...
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    Wiki Masseter Muscle

    My provider wants to do a bilateral masseter muscle injection. Most of what I'm finding is for a botox injection (CPT 64611 or 64612). At this point, my doctor is looking at a Depo-Medrol injection to this muscle. Would it be the same code for the botox injection or would a trigger point code...
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    Wiki Pain Pump Refills

    So every time I think we've got the billing for the pain pump refill medications figured out, we start getting denials. The latest denial I received was from Medicare that the CPT/HCPCS were billed incorrectly for compound drugs. I billed as J3490-KD. The drug combination is: Fentanyl Citrate...
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    Wiki Modifier help

    Does anyone know if there is a modifier that can be used when billing J0490 with 2 different NDC #'s such as J0490. TIA
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    Wiki Pain Pump Medications

    I have an Ohio BWC (Sedgwick) claim for a pain pump refill for a Prialt pump. I normally bill J2278 for the Prialt and they have paid this code in the past. On the current claim I have they are telling me that I need to change the J2278 to 99070 with the drug information. They are saying that...
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    Wiki Intercostal Brachial Nerve Block

    Does anyone know if this would be 64420 or 64415? I'm finding some contradictory information on this. Thanks in advance
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    Wiki 62350, 62368 & 61070

    Any insight would be greatly appreciated. So, my pain doctor performed a catheter revision (62350) on a patient and also performed a patency (61070) and programming (62368). I'm not seeing that there are any edits for these codes, but also reading the description for 62350, it looks like code...
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    Wiki MBB injections

    Quick question - What is the maximum number of joints that can be injected for an MBB? The LCD states for therapeutic injections and my doctor is looking for diagnostic injection count. Does anyone know where I can find the information, I'm not having any luck. Thank you
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    Wiki BWC Pain Pump Refill claim

    For anyone familiar with Ohio BWC claims - I have a claim for BWC that they have denied the drugs for the pain pump refill. I billed J2278 (Prialt), they have paid this in the past and now with this claim they are stating that I should bill 99070 with the NDC # for the drugs in place of J2278...
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    Wiki 62368 during postoperative period

    My provider placed a pain pump and during the postoperative visit (99024) performed an adjustment (62368). Since this is during the global period for the pump implantation, the adjustment would be considered as a normal component of the postoperative visit and would no be separately billable...
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    Wiki Dye study & programming

    I'm looking for a little input on this claim. My pain management provider did a dye study under fluoroscopy and reprogramming of the pain pump, he had coded 61070, 77002, 62368. I know 77002 is bundle w/61070 and is not separately billable. From what I know of the dye study, according to his...
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    Wiki Pain Pump Adjustment & Office Visit

    I'm in need of a 2nd opinion - the discussion in my office is that an office visit should be billed with the following. The provider did a pain pump adjustment (CPT 62368), he also had a lengthy discussion with the patient about having the pump removed because the patient wasn't getting any...
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    Wiki Urology Coding

    I was asked my one of the urology coders where I work if I knew urology coding.. I'm familiar with urology coding, but not fluent in the specialty.. I would like to become more fluent with this specialty and expand my coding, currently my coding specialty has been limited to Anesthesia & Pain...
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    Wiki 64625 - RFA SIJ

    I'm looking for some additional information on the new cpt 64625 - RFA Sacroiliac Joint, specifically if this code can be billed with multiple units? Say if the provider performs this procedure on S1, S2 and S3. Thank you in advance
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    Wiki RFA Sacroiliac joint, L5, S1, S2 and S3

    Some input on this claim would be greatly appreciated. I'm having a hard time finding a dx that MMO will pay on this procedure. Diagnosis used: M46.1, M53.3, M47.817. Everything I'm finding is showing it should be coded as 64640 x4. Some information I've found is saying it should be coded as...
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    Wiki Baclofen Pump Refill

    Would it be more appropriate to bill J0475 (Injection, baclofen, 10mg) or J3490 for a baclofen pump refill? I'm leaning more towards J3490. The drugs used are: Baclofen. Sodium Chloride & Sterile Water. Any input would be greatly appreciated.
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    Wiki CLIA Question

    I have a pain management provider that performs UDS in the office and has a CLIA certificate. We bill 80305-QW and we keep getting denials "Provider was not certified/eligible to be paid for this service/procedure on this DOS". I have 2 questions on this: 1. With the CLIA certificate, is any...
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    Wiki C9290 for Pain Pump Refills

    The office authorization personnel got an authorization for Aetna Duals insurance for J2274/C9290 for a pain pump refill. From what I'm finding C9290 is only billable in an ASC setting and not an office setting. The pain pump meds are: Morphine Sulfate Pentahydate 100gm/904mg+Bupivicaine HCI...
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    Wiki Pain Pump Refill - Dilaudid

    Patient had a pain pump refill with only Dilaudid, Sodium Chloride and Sterile Water. Insurance denied for no authorization. This was billed under the unlisted "J" code for the pump refill. The authorization person in the office is stating this should be billed using J1170 for the Dilaudid only...
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    Wiki Excision Cyst Neck & Head

    The doctor performed an excision of an Epidermal Inclusion Cyst and a Pilar Cyst of the anterior neck and back of the scalp. The diagnosis according to the path report is L72.0 & L72.11. The surgeon's coder coded the procedure: Scalp Excision: 21011 (Excision, Tumor, soft tissue of face or...
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    Wiki Common Peroneal Nerve Block

    Looking for some insight on this NB - Common Peroneal NB - in looking up the anatomy it looks like it is a branch of the sciatic nerve. I'm thinking it should be coded 64450, my doctor is saying 64445. Op report info is below: The area of the common peroneal nerve being cleansed with...
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    Wiki Lumbar RFA

    Any input on this would be great.... My provider performed a Lumbar RFA on L4 and dorsal ramus of L5... which should be 64635 since it is one level. The insurance company denied 64635 and approved 64636. The person that does our authorizations explanation is below, the insurance is Anthem...
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    Wiki SIJ Injection in ASC setting

    HI, I just started receiving denials from UHC for my pain management provider performing CPT 27096 in an ASC setting. Stating they only cover this in an office setting. Encoder has that this as a Nonsurgical procedure not Medicare allowable in an ASC. I know for most insurances when this...
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    Wiki Hospital Admit during global period

    So my provider has a patient he performed a SCS implant, the patient went to Emergency Dept for pain and redness at the incision site. The patient was admitted and my provider saw her in the hospital 3 times. The first date actually falls on the last date of the global period. Will I be able to...
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    Wiki 64600 - Bilateral

    I have a claim the provider performed a bilateral supraorbital RFA at the branch of the trigeminal nerve and the insurance (Anthem) denied with modifier -50. According to Encoder this code does is not billable with modifier -50 or RT/LT. From diagrams I'm seeing, it appears that there is a...
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    Wiki 95972 billing

    So, I have been getting denials for 95972 when billed with SCS implant. I've tried billing this with modifier -51 or -59 with no luck. The insurances keep denying as inclusive, I'm thinking there maybe needs to be more detailed documentation for the post-operative programming in order to bill...
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    Wiki 76942 billing

    My pain doctor does procedures in the ASC and takes his own ultrasound machine down to use. Would I be able to bill 76942 globally with no modifier (-26) since he is using his machine and not the ASC's. I have a claim that the insurance has denied for invalid modifier for this code. Thank...
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    Wiki Obtruator & Femoral Articular branches of hip nerve block

    Any input would be greatly appreciated.... This is a new one for me... my provider performed a nerve block of the obturator and femoral articular branches of the hip. He's wanting to code 64450 x 2. Would this be most appropriate way to code this procedure. I'm not having any luck finding any...
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    Wiki Left Lateral Branch NB

    The pain doc performed a left lateral branch nerve block for sacroiliac joint specifically dorsal ramus of L5 and lateral branches of S1, S2. He wants only 64450 x3 coded. In the note I don't see any documentation that he actually injected at the L5, so I believe this would be correct...
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