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Meaning of surgical cascade fourth and subsequent by report?

John Posted Fri 28th of June, 2013 18:35:41 PM

We coded the following: 99213-25, 64415-50, 64413-50, 51, 64450-50,51, 64450-50,51, 64450-50,51, 64450-50,51; A copy of the office and procedure note were sent with the original claim.

We were paid on the first four codes, but the last two (64450-50,51, 64450-50,51) were denied, with the reason code stating, "surgical cascade fourth and subsequent by report"; How can we code this better? and what does "surgical cascade fourth and subsequent by report" mean?

SuperCoder Answered Fri 28th of June, 2013 21:36:31 PM

The surgical cascade note seems to be the payer remarking on the long list of codes and a policy to review the reports before paying for the fourth and subsequent codes to ensure they meet coverage criteria. It's possible that on review the payer determined the last two would not be covered. Given that these all represent bilateral services, there may not be a better way to code (e.g., units), although it's hard to say without knowing the sites involved. If 64413 is your highest RVU service, take a look to see if mod 51 should be on 64415 instead. (The payer may do this automatically.)

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