# facet w/ transforaminal



## dwaldman (Apr 1, 2010)

Can you bill a transforaminal epidural and facet injection on the same side same level? I noticed these codes  do not have bundling issues but I was questioned if it was appropriate to bill both 64493 and 64483 together.


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## rkmcoder (Apr 1, 2010)

Below is a quote from a Medicare LCD (check the LCDs for your jurisdiction).

"An epidural (62311), transforaminal epidural (64483, 64484), sacroiliac joint injection (27096), or lumbar sympathetic block (64520) should not be performed on the same day as facet joint nerve block injections. Furthermore, only one type of a block or injection should be performed in a given session so that the effectiveness of its treatment can be assessed prior to attempting another type of spinal block or injection."

Other insurance carriers may have different regulations.  So file your claims, wait for the outcomes, then educate your doctors.

Richard Mann, your pain management coder
rkmcoder@yahoo.com


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## dwaldman (Apr 1, 2010)

Our LCD also says that . I think she was asking would it be proper code both injections if the procedure were performed. Like is there reason that you shouldn't bill both of those based on anatomy, if one procedure would be duplicating the goal of the other procedure, or other coding principles outside of LCD gudiance. She works for billing company so I don't know that she contact to educate the physician on this note in the facet LCD.


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## rkmcoder (Apr 1, 2010)

Okay, here is another way to look at it.  A facet injection is a diagnostic procedure.  Any other procedure done at the same time in the same vicinity could mask/alter/destroy the results of the facet injection, thus rendering the facet injection useless.  But if the doctor did both of the procedures, then of course you will bill for it.  You may get paid - you may not get paid.

Richard Mann, your pain management coder
rkmcoder@yahoo.com


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