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Denial Code CO-107

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oneround:
I believe Anand might have it coorect on this one



The series of codes 64479-64484 describes transforaminal epidural injections of an anesthetic agent and/or steroid. Transforaminal epidural spinal injection techniques are a different approach compared to central epidural injections. Because the vertebral artery as well as the spinal cord is in close proximity to the nerve root, the transforaminal injections are more difficult to perform.

The code descriptors identify the spinal anatomy, the substances injected and the spinal level(s) involved. CPT codes 64479-64484 are unilateral procedures. Therefore, when bilateral
transforaminal epidural injections are performed, the modifier -50 should be appended.

Also, is this the only code that you are using?

mcrbiller:
Sometimes the claim is billed out using 64483 and 64484. Sometimes it's billed w/fluoro(77003) and sometimes without. Some claims pay and some don't.

oneround:
These codes can be reported together as the 64484 is an additional code: 64483 Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level 64484 Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, each additional level (List separately in addition to code for primary procedure)

Also, on the fluoro are you attachinbg Mod 59?  Also remember that  77003 is intended to be reported per spinal region (eg, cervical, lumbar) and not per level.

You should be able to appeal those denials

mcrbiller:
Thank you all for the advice. I'm going to correct these and rebill.

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