# ? correct CPT codes - Using fluoro guidance 22 gauge



## Kimberley

Would 64490 be appropriate for #1 and 64450 for #2

1.      Using fluoro guidance 22 gauge spinal needle was advanced toward the inferior aspect of the facet joint. Once within the joint, an injection of Celestone mixed with Marcaine was injected. The stylet was replaced the needle was removed. Procedure repeated on the left. IMPRESSION: bilateral L5-S1 facet joint injections with a mixture of Celestone and Marcaine.

2.      The skin entry site at the level of the C7nerve root on the left was marked. Skin prepped – using CT guidance 22 gauge spinal needle was advanced towards the exiting C7 nerve root on the left – small of nonionic contrast confirmed extravascular location. Marcaine and Celestone was slowly infused. The patient did note shoulder pain once the needle was in the location of the nerve root. Relief was noted upon injection of lidocaine. IMPRESSION: CT guided selective nerve root block of C7 on the left.


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## bethh05

The lumbar facet injection would be 64493 x2-for the bilateral procedure (this also includes the flouro).
64479 for the cervical nerve root block, this code does not include flouroscopy so you can use 77003 depending on the insurance, MCR will not reimburse for the flouro.


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## Kimberley

Please explain to the mean the difference between:

64490 and 64450


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## bethh05

64490 is for Facet joint injections-facet joints connect bones in the spine. 64450 for nerve roots, which are attached to the spine and grow out of each side of the spinal column at every spinal level. The physician indicated he performed a_ Selective _nerve root block which is also known as Transforaminal injections(CPT 64479-64484 and these are specified for what level was injected;cervical or thoracic and lumbar or sacral).


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## tadavis

I agree with bethh05-- I would bill it: 64493 with mod 50 for bilateral procedures and 64479, and 77003 with mod 26


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