Tuesday, July 27, 2010

Billing spinal injection CPT 64470,64472,64475 AND 77003

Spinal Injections.

Injection procedures are billed in the same manner as all other surgical procedures with the following considerations:

1.    For purposes of multiple procedure discounting, each procedure in a bilateral set is considered to be a single procedure.

2.    For injection procedures which require the use of flouroscopic localization and guidance, ASCs may no longer bill separately for the technical component of the radiological CPT code (e.g., 77003 –TC ).  Payment for these codes is bundled into payment for the primary procedure.

Example:  Injection Procedures with flouroscopic guidance, Chicago, IL.

Line item    CPT code        Maximum    Bilateral/Multiple    Allowed
  on bill      modifier         payment     policies applied    amount

    1    64470–SG–50        $668.18           $1,002.27                $   1,002.27(1,2)
    2    64472–SG–50       $289.90            $434.85(3,4)          $      434.85
    3    64475–SG             $600.12               $300.06(5)           $      300.06
    4   77003–TC         $    0.00(6)             $    0.00                $          0.00
    Total allowed amount                                                       $   1,737.18(7)

1.  Highest valued procedure is paid at 100% of maximum allowed amount.
2.  Bilateral payment policy applies 150% multiplier to maximum allowed amount.
3.  The multiple procedure payment policy is not applied in this case because 64472 is an add-on code to 64470.
4.  When applying the bilateral procedure payment policy to a secondary line item billed with a modifier -50, the bilateral multiple is applied before the multiple procedure reduction if applicable for that line item.
5.  When applying the multiple procedure payment policy, the secondary procedure max allowable is reduced by 50%.
6.  Flouroscopic guidance is bundled into the primary procdure.
7.  Represents total allowable amount

    Exception:  HCPCS Code G0260 cannot accept modifier -50 or any other multiple procedure modifier.

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