Multiple reporting is dictated by payer guidelines

While billing for multilevel radiofrequency, we code 64622 for the first level and +64623 for each additional level up to a total of four. Our payers reject the fourth level as a duplicate, even if a modifier has been appended. How should we distinguish between the third and fourth levels so that they both will be reimbursed?

For the first level, you are right in reporting 64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level) and for additional levels, +64623 (…lumbar or sacral, each additional level [List separately in addition to code for primary procedure]).

Choice: You might need to include an additional note stating 'three additional levels' next to +64623. Now if all the levels were on the same side, you could also bill the add-on codes as a single line item and three in the 'units of service' field, 24G of the 1500 form(). For instance, code 64622-RT (Right side) on line one of your claim and +64623 x3 RT on line two. For fluoroscopic guidance include any codes such as 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, subarachnoid, or sacroiliac joint], inclusive of neurolytic agent destruction).

Some payers will not pay for multiple units while others have certain ways to submit the claim. Still others limit the number of levels the doctor can ablate during a single session. An electronic system might not permit you to bill more than one modifier, meaning that you should submit a paper claim. Due to these types of variances, check your local guidelines to figure out the best way to submit the claim.