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Knee Injections

Brady Posted Tue 10th of July, 2018 16:06:36 PM
We need the following Procedure Coded. We were told to bill as 64450 59, 64450 59, 64450 59 on three separate lines BUT Medicare is not paying indicating invalid HCPCS code. They paid on the first two lines and deny the third. We need to upload the procedure details
SuperCoder Answered Wed 11th of July, 2018 04:39:53 AM

CPT 64450 is for injection, anesthetic agent; other peripheral nerve or branch. In this procedure, the provider injects an anesthetic agent to relieve pain in a single nerve or group of nerves to relieve pain or a blockage. This code is paid on the basis of number of nerve innervation performed. For example, when the procedure is performed on the tibial nerve, superficial peroneal nerve and sural nerve, then as of general coding guidelines, it can be billed as follows:

  • 64450-RT/LT (Modifier RT or LT for Right or Left, accordingly)
  • 64450-59, RT/LT (Modifier 59 to identify Distinct Procedure Service and Modifier RT or LT for Right or Left)
  • 64450-59, RT/LT (Modifier 59 to identify Distinct Procedure Service and Modifier RT or LT for Right or Left)

Check your medical document on which all the nerves it has been performed and re-bill accordingly.

Also, make sure to justify the medical necessity of the procedure.

SuperCoder Answered Thu 12th of July, 2018 05:24:12 AM

The knee joint is innervated by the articular branches of various nerves, including the femoral, common peroneal, saphenous, tibial, and obturator nerves. These branches around the knee joint are known as genicular nerves.

As per provided op-report, it is mentioned that Superolateral, superomedial and inferomedial have been blocked for the genicular nerves.

So, if the provider specifically documents in the record that he has performed injections in different branches, you can use multiple units of code 64450 (Injection, anesthetic agent; other peripheral nerve or branch).

  • 64450-RT/LT (Modifier RT or LT for Right or Left, accordingly)
  • 64450-59, RT/LT (Modifier 59 to identify Distinct Procedure Service and Modifier RT or LT for Right or Left)
  • 64450-59, RT/LT (Modifier 59 to identify Distinct Procedure Service and Modifier RT or LT for Right or Left)

Some payer suggest to append modifier 51, check the payer policy and use modifier 51 accordingly.

Brady Posted Tue 07th of August, 2018 14:14:34 PM
Medicare of PA is still denying. They pay 2 lines and deny the third. We have tried the 59 modifier on all 3 lines. Also tried 51 modifier on all lines. No LCD Policy is showing. Could it be that they will only pay 2 lines?
SuperCoder Answered Wed 08th of August, 2018 05:15:04 AM

As described earlier, modifier 51 and 59 will not be appended with all three lines, do not append modifier 51 and 59 with primary code (first line code), append these modifiers with next two codes. On the other hand, check your documentation, injections should be given to separate nerves or the different branch of nerve, if more than one injection has been given to the same branch of nerve then payer will pay only for one injection. Make sure to check the reason of denial, resolve it and re-bill.

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