Coding > Coding

20552 & 64405

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Billergirlnyc:

--- Quote from: mbloom on June 28, 2013, 01:46:50 AM ---I see....so that means that 64405 and 20552 will pay incidental. Or do I use a 59 on 20552 to indicate two separate procedures and should I be reading provider notes to make sure it should be billed as 2 separate procedures....


 :o

--- End quote ---

They're NOT inherently incidental. SOME carriers don't pay for them on the same day per their policy or the patient's but this doesn't make them incidental across the board. If modifier 59 is appropriate in your situation then you can append it to the 20552 because the code allows it. But you still need to confirm with the carrier on their rules for doing both injections on the same day.

Now, when I say that 59 modifier can be appended it means it must follow the coding rules, which you can research to confirm and of course back-up with documentation (patient notes). You should always confirm with your client/the doctor that both procedures are properly documented so you know how to bill for it, so yes look at the notes (if you're a coder), if not then just ensure you client confirms the CPT codes to be billed via an encounter form/superbill. But you need to educate your client on how these codes CAN be billed regardless of what they circle or write on the superbill. I've never seen a doctor do a greater occipital nerve block in any other place than the facial/head area -- see this link ---> http://www.preferredpaincenter.com/occipital-nerve-block.html so you can better understand the type of injection a nerve block is, especially the greater occipital one. The TP codes 20553/20552 are injections in the MUSCLES NOT NERVES -- see this link to see what they are---> http://www.preferredpaincenter.com/trigger-point-injections.html# and I often seem them injected in the back area or neck area, but I've also seen it done in other areas too, but never in the head or facial area. So there SHOULD be 2 different reasons for doing both injections but perhaps in your case it's not. Check the documentation and with your client.

See my original response which covers some of this.

mbloom:
Thanks again! Very, very helpful!

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