# 64520 multiple levels



## dwaldman (Apr 12, 2010)

Can 64520 be billed with more than one unit in the same anatomical region?

"About 12 cm lateral to the right of midline, a 5-inch 22-gauge spinal needle was advanced in until the trasverse process o f L2 was first contacted. The needle was then dirrected slightly caudally and medially and advanced in until the body of the vertebrae was pass the lateral edge of the vertebral body at L2. The same identical procedure was repeated at the L3 and L4 on the right side. Following this 0.25 cc of Isovue 300 was injected visualizing excellent placement of needles in the lumbar sympathetic area. Roughly, about 4cc of 2% lidocaine with 7.5 mg of kenalog was injected at each side L2,L3,L4"


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## rkmcoder (Apr 12, 2010)

(These are my opinions and should not be construed as being the final authority.  Other opinions may vary.)

http://www.cms.gov/NationalCorrectCodInitEd/08_MUE.asp

Click the above link to find the Medicare MUEs for 2010 Q2.  64520 has an MUE value of 2.  It is my understanding that this means that the code can be billed up to two times on the same claim without triggering a need for documentation.  The verbage used on the CMS website is; "An MUE for a HCPCS/CPT code is the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service."

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


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## Thath041 (Sep 30, 2011)

I was under the impression MUE's that had a 2 were for RT / LT ? Is this not the case? So it could be used for Multiple levels? EG: L2 or L3 RT side


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## dwaldman (Oct 3, 2011)

Thank you for your response, I had posted this question before the following was published in December 2010 CPT Assistant:

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Questionoes the intent and use of code 64520,Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic), allow for multiple unit reporting when performed in several spinal thoracic levels? Is code 64520 reported only once to represent all injections performed in that spinal region? For example, a physician performs “incremental” lumbar sympathetic injections via separate needle placement and injections anterior to the L1, L2, and L3 vertebral bodies (ie, paravertebral lumbar sympathetic ganglia). Is it appropriate to report code 64520 with three units of service or just one unit of service?Marvel J Hammer RN CPC CCS-P PCS ACS-PM CHCO, Denver, CO

Answer:Even though multiple injections including contrast material are performed into a single nerve at a given level, code 64520 is reported once when performing injection(s) of a lumbar paravertebral sympathetic nerve at a single level. Therefore, for the stated L1, L2, and L3 levels involved, it is appropriate to report code 64520 three times. The fluoroscopic guidance is reported once for all of the injections performed in the lumbar region with code 77003, Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, or sacroiliac joint), including neurolytic agent destruction, as code 77003 is reported by spinal region (eg, cervical, thoracic, lumbar) and not per spinal level.


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