tci Medicare Compliance & Reimbursement - 2011 Issue 5

Reader Questions: Stick With Correct Code, Even if Non-covered

Question: Our Medicaid carrier included codes 64470-64476 on the 2009 physician fee schedule, but dropped them in 2010 as noncovered services. The latest schedule also does not include new codes 64490-64495. I have enough documentation to determine an acceptable E/M service level. Can I report and E/M code instead of the facet injection so our provider gets paid something?Answer: Coding guidelines direct you to code the service your physician provided and documented, whether you expect payment or not. Choose the appropriate code from 64490-64495 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint]...

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