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64635 and 64636 denials

Melissa Posted Wed 20th of April, 2016 14:44:16 PM
We are suddenly getting denials when billing 64635 and 64636 to CMS. We called and they said we needed to add an unbundling modifier. did I miss a change? They are paying 64636 and denying 64635
SuperCoder Answered Thu 21st of April, 2016 08:06:39 AM
Hi, The code descriptors for 64633-+64636 apply to "nerve(s)." That means a code can represent destruction by either a single nerve injection or multiple injections to that joint. However, if your provider injects bilateral nerves at a single level, you will need to report the service as a bilateral procedure. CPT® intends these new codes to report unilateral procedures. Many payers request that you append modifier 50 (Bilateral procedure) to the CPT® code to designate a bilateral procedure. Verify whether this is the case for your payer in question. If not try to bill with modifier 59. For some reason Medicare is requiring mod 59 for add-on codes, even though they shouldn't based on the code descriptions. The only thing I would check is look up the MUE's on the CMS website and make sure there isn't a limit to the number of levels that would prevent you from billing the way you want. If there is no MUE, or it's high enough to allow your levels, then add modifier 59 to the duplicate add-ons and see if that works. Thanks

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