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radiofrequency spinal codes

Mike Posted Fri 04th of March, 2016 12:37:12 PM

I have a payer that is not paying bilateral claims correctly.Patient had bilateral RF on L3-L4 L4-L5 and L5-S1. We billed 64635 50 and 64636 50 and 64636 59-50. They think 63636 is the same procedure and only paid this code once.

I need documentation that a add on code like 64636 CAN be billed for EACH additional level. (multiple times on a claim) I tried to tell them that there is not a separate code for radiofrequency on every level of the spine, but they just don't get it.

SuperCoder Answered Tue 08th of March, 2016 08:43:38 AM

I have given additional option below:
64635-LT
64635-RT
64636-LT x 2
64636-RT x 2
Some payers require for RT/LT.

Mike Posted Thu 10th of March, 2016 20:41:09 PM

No, not BCBS. They think you can only bill the add on codes 64634 and 64636 only ONCE on a claim in addition to the 64633 and 64665 primary codes.

I need something from the maybe from CPT assist that states how this code is bill when multiple levels are done. They don't understand the CPT book wording.

Can you help me with some documentation on 64636 and 64634?

SuperCoder Answered Fri 11th of March, 2016 08:53:35 AM

Please go through below mentioned links:

http://www.mspinkymaniri.com/2014/11/how-to-code-and-bill-for-radiofrequency-ablation/
https://downloads.cms.gov/medicare-coverage-database/lcd_attachments/30483_19/L30483_NEURO008_CBG_010112.pdf
https://www.supercoder.com/cpt_assistant/cpt_assistant_details/2827

I hope this will help you!

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