Denial Reason, Reason/Remark Code(s)
- M-80, CO-18 - Duplicate Service(s): Same service submitted for the same patient, same date of service by same doctor will be denied as a duplicate
- CPT codes 64470-64476
Resolution/Resources
- Use the appropriate modifier to designate whether services are unilateral (specify which side of the joint) or bilateral
- Unilateral blocks: submit HCPCS modifier RT or LT
- Bilateral blocks: submit CPT modifier 50
- Submit a single claim for all facet joint injections administered for the same patient on the same date of service. Claims for multiple injections that are submitted on different claims may be denied as duplicate services.
- Submit additional information in Loop 2300, or 2400, NTE, 02 for electronic claims, or as attachments when paper claims are submitted, in the following situations:
- When injections are administered at multiple spinal levels, identify the specific levels (e.g., T11-12, L2-3, L4-5, and L5-S1)
- Multiple sets of paravertebral facet joint injections are performed for a beneficiary over a period of time: submit documentation to explain the reason for the number of injections relative to the patient’s condition
- When the beneficiary’s pain is controlled by facet blocks, explain why a more permanent method of control, such as neurolysis, was not used
Reference: