CPT code 64475/64476

[kcoffiner]

Hi: Not sure if anyone can help me out with this one. I work for an orthopaedic practice with a pain mgmt physician. The pain mgt physician performed CPT code 64475 under guidance 77003 and add on code 64476 X 3. We billed as follows

64475 X 1
64476 X 3
77003 X 1
J3301 X 8

We are receiving rejections based on lack of modifers? Any help with be greatly appreciated.

[Michele]

Not 100% sure but it looks to me like you need to either indicate RT or LT, or else 50 for bilateral.

Michele

[Priyan]

64475 for a single level of lumbar or sacral level and 64476 for each additional level.

Billing is 100% correct. in addition, floroscpic guidence may get denied as inclusive to 64475.

Incase of CO 50 "not medically necessity", your medical records will suport the purpose of service.

go thru the following address

http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=29252&lcd_version=3&show=all