Medical Billing Forum

Billing => Billing => : carmen.nprc February 03, 2014, 05:19:26 PM

: modifier vs. units please help
: carmen.nprc February 03, 2014, 05:19:26 PM
I work for a newly opened Neuropathy Pain Relief Center, and I am having some problems with the billing.
We treat Peripheral Neuropathy.
Using a combined Nerve block (64450)
1 treatment per visit consists of:
3 injections (in the same foot) treating 4 nerves
with Ultrasound Guidance 76942
E-stem g0283
Ive been told to use 59 modifier behind 2nd & 3rd 64450. But then told that 59 is becoming a flagged code.
Ive been told to use 76 modifier behind 2nd & 3rd 64450
Ive been told to use 3units & no modifier behind 2nd & 3rd 64450

If anyone has some insight to this problem please let me know. I can't find an answer.

Thank you
: Re: modifier vs. units please help
: Michele February 04, 2014, 12:43:03 PM
I'm assuming you are the biller and not a certified coder, right?  So I have to ask, when you say "I've been told", who is telling you?  The provider?  If the provider is telling you to bill it a certain way then you must bill it that way.  You shouldn't change anything in order to get payment.  If you suspect that the coding is not correct it is ok to go back to the provider and explain why you feel it isn't correct and ask if they want to change it.  I'm just trying to make sure you don't get into a gray area here.  It is easy for a biller to get caught up in trying to get things paid because, after all, that is our job.  But you don't want to do anything that can get you into trouble.   

So with that being said:

I don't have any specific experience with this but you might want to look at suggesting the 51 modifier.  When I research it that seems to be what is indicated.  Also, have you searched the LCD's or NCD's?  Even if it's not Medicare it may be helpful.

: Re: modifier vs. units please help
: Haward February 07, 2014, 08:17:18 AM
I agree with the above post, I think you should consult with any expert in coding and billing profession so that you can easily get over with this problem. For my medical billing, I have outsourced the services to Red Engine System