“We have been finding that, just recently, United Healthcare has a problem with the combination of CPT 64450 and CPT 76942. They are paying the CPT 76942. We have appealed with medical records and CPT 64450 still being denied. We have resubmitted with a 59 and are waiting on response. Is anyone else experiencing the bundling of these two codes?”
CPT code 64450 is defined as the following: Injection anesthetic agent(s) and/or steroid; other peripheral nerve or branch
CPT code 76942 is defined as the following: Ultrasound guidance for needle placement (eg. biopsy, aspiration, injection, localized device), imaging supervision and interpretation
When the NCCI edits are accessed, CPT codes 64450 are not bundled and are theoretically able to be billed together on the same extremity on the same date of service. I know that an appeal was filed and the medical records were submitted. Hopefully, what was also submitted was a copy of the ultrasound image that identified the nerve that was injected and required and demonstrated the ultrasound guidance to perform the injection and a hard copy “written report” to indicate the specific nerve that was injected and to show how the ultrasound guidance was required and and utilized. When the Radiology Section/Chapter of the CPT Manual is accessed, under “Radiology Guidelines,” specifically under “Written Report(s),” it clearly states: “A written report (eg. handwritten or electronic) signed by the interpreting individual should be considered an integral part of a radiologic procedure or interpretation.”
There can be more to the story. It is possible that even though CPT codes 64450 and 76942 are not bundled together that United Healthcare is misinterpreting this procedure set as the following: CPT code 76942 is the procedure being performed and CPT code 64450 is being used to administer local anesthesia in order to perform the procedure. Clearly, this is not the case, but this just might be United Healthcare’s interpretation of what was performed and why CPT 76942 was reimbursed and CPT 64450 was not reimbursed. This just might be what needs to be pointed out to United Healthcare.
This is my opinion.
Michael G. Warshaw, DPM, CPC
GREAT NEWS!!!
THE 2022 Podiatry Coding Manual is now available in either Book or Flashdrive formats. It has been completely updated including the E/M coding changes. Many offices across the country consider this to be their “Bible” when it comes to coding, billing and documentation. The price is still only $125 including shipping! To purchase, access the website drmikethecoder.com.
No credit card? No problem! Just send a check for $125 to the following address:
Dr. Michael G. Warshaw
2027 Bayside Avenue
Mount Dora, FL 32757
Are you in compliance with Medicare concerning your billing, coding and documentation? An audit should never be more than an inconvenience. It should not be a life altering event. Find out your status before you are audited by your Medicare carrier. Drmikethecoder special: Have 5 dates of service audited for $250 (new clients only). Contact drmikethecoder.com for more information.
Read Comments