# help needed with 64420 & 64421



## susie59 (Jun 17, 2011)

(sorry, I had my codes backward)

I am still a little confused over these two codes and how they are to billed appropriately.  I  would really appreciate some guidance. 

T8/9/10/11/12 were all injected. What would be the proper coding? Would 64420 be used for the first level followed by 64421 with a modifier? Would 64421then be billed more than once? 



Thank you for your help with this.


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## astephens (Jun 23, 2011)

what are you trying to bill? what type of injections?


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## susie59 (Jun 23, 2011)

Hi, I posted a portion of the OP note below... Thanks for your help with this.

Indications
Patient presents with intractable left thoracic burning pain after radiation to thoracic spine for metastatic cancer. Has failed conservative
treatment with medication management and Thoracic epidural steroid injections and Thoracic Facet Blocks. At this juncture decision to
proceed with ICNB for diagnostic +/- Therapeutic purposes.
Risks/Benefits/Alternatives were discussed at length with the patient. Informed consent was obtained.
Procedure
Patient was positioned prone on the operating room table. After appropriate sedation by Anesthesiologist the patient was prepped and
draped in the usual sterile fasion over the left thoracic ribs. Skin wheel was raised over T8 thru T12 approx 7 cm left of midline with 1%
lidocaine using a 27 ga needle.
Starting at T8 rib a 3.5 inch 23 ga spinal needle was advanced until it touched the inferior aspect on the rib and then walked off to
position in the intercostal groove. 1 cc of omnipaque was then injection to confirm needle placement. Spread was noted in a linear
fasion in the groove. No vascular uptake was noted. 2ml of 0.5% bupivicaine mixture with depomedrol was injected. A second similar
injection was done 3 inches from midline at same level with phenol 2 ml 3% to ablate nerve.
This procedure was repeated in a similar fasion at the T9 thru T12 levels. Total dose of 80 mg depomedrol was utilized.
Patient tolerated the procedure well.
No complications were noted.


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