# T12-L1 Thoracic or Lumbar...HELP!



## billingchic#1

Okay, I'm a little confused. The CPT 2010 book says facet injection at T12-L1 is considered lumbar, but the new CPT 2012 for 64490 states "includes T12-L1". Also, for transforaminal injections, T12-L1 is said to be considered lumbar. Why are transforaminals lumbar and facet injections thoracic. I have never billed T12-L1 as thoracic, always lumbar. Given, the 2010 book I have is AMA and the 2012 CPT book is INGENIX. Anyone have any clarification? Please help!!


----------



## dwaldman

Currently, T12-L1 is considered a thoracic level for both transforaminal and facet injections. 

For transforaminal approach at  T12-L1, this is considered thru the T12 foramen where the T12 spinal nerve exits.

For facet joint blocks, the T12-L1 facet joint receives innervation from the T11 and T12 medial branches.


----------



## billingchic#1

64479 is what we would report for T12-L1, but what if the physician does tranforaminal on T11-12 and T12-L1? You would report T11-T12 with 64479, but the addtl level, 64480 excludes T12-L1 would that be considered lumbar?


----------



## aaron.lucas

If you read the parenthetical notes in AMA CPT Professional 2012 it states "for transforaminal epidural injection at the T12-L1 level, use 64479".  similarly for "...facet injections at T12-L1, or nerves innervating that joint, use 64490".  In both cases you would use the initial level/joint code for T12-L1, then the add-on for any additional Thoracic levels/joints.  So in the above case it would be 64479 for T12-L1, and 64480 for T11-T12.  I know it sounds backwards but that's what the book says.


----------



## ckkohler

what if the doc does facet block @ T12-L1 and L1-L2?  Initially, I used what came up in EMR - 64490 for the T12-L1 and 64493 for the L1-L2 - however, since both codes are the initial injection - it didn't seem right to bill like that ... should I reduce the 64493 fee to what an additional level would cost and use modifier -52?


----------



## dwaldman

The injections are spanning two separate spinal regions and since the codes are different I would follow the way it should be reported with 64490 64493 without reduction or modifier 52 since the service was initial thoracic block and an initial lumbar block completed to the full service which would exclude using 52. The volume of patients requiring T12-L1, L1-L2 compared to majority of complaints in the lower lumbar or cervical region makes this coding scenario not an everyday or weekly occurance.


----------



## hgolfos

Great question Carolyn! 

dwaldman, I was leaning that way myself... I actually had precisely this scenario yesterday when I first read this post.


----------



## LadyJ317

*I need help too*

Ok, I am reading the post and it is very good information! I am having the same issue with my doctor. He is stating he is giving the injection in T11, T12, L1, and L2. So if 64490 is covering T12-L1 and 64493 covers L1-L2 what about T11? What code would I use for that?

Thanks for your help!


----------



## aaron.lucas

It should go like this:

T12-L1= 64490
T11-T12= 64491
L1-L2= 64493
L2-L3= 64494

And remember, no billing for fluoro along with it.  This is basing the initial Thoracic level on the parenthetical notes, with the add-on, and then the initial lumbar with the add-on.  Hope this helps!


----------



## dwaldman

T11, T12, L1, and L2.

What does these above represent the medial branches blocked:

T11, T12 innervating T12-L1 64490
T12, L1 innervating L1-L2 64493
L1,L2 innervating L2-L3 64494

Or is  T11, T12, L1, L2 anatomical locations of the injections

T10, T11 innervating T11-T12 64490
T11, T12 innervating T12-L1 64491
T12,L1 innervating L1-L2 64493

Need to confirm what facet levels were treated (T12-L1, L1-L2, L2-L3) or (T11-T12, T12-L1, L2-L3) It seems with the spinal region being crossed that this could effect which add on would be selected. Is medial branches being described or the anatomical locations that where the injections took place.


----------



## mhstrauss

dwaldman said:


> Currently, T12-L1 is considered a thoracic level for both transforaminal and facet injections.
> 
> For transforaminal approach at  T12-L1, this is considered thru the T12 foramen where the T12 spinal nerve exits.
> 
> For facet joint blocks, the T12-L1 facet joint receives innervation from the T11 and T12 medial branches.



Can this same logic be used for the interlaminar injection codes 62310/62311?  My physician performed an interlaminar steriod injection at T12 - L1.  I thought I remembered coming across guidance specifally for the 62310-62311 codes, but of course now that I'm looking for it, I can't find it.  Any help would be much appreciated!


----------



## dwaldman

T12-L1 joint is innervated by T11, T12 which are thoracic medial branches. The intervertebral foramen at that level would be T12 and would be the T12 disc. So could report 62310. For ICD-10 you would need to know thoracolumbar, thoracic, or lumbar; whereas, the current code 724.4 is either or can be both.


724.4  
   Thoracic or lumbosacral neuritis or radiculitis, unspecified  

M54.15  Radiculopathy, thoracolumbar region  

M54.14  
Radiculopathy, thoracic region  


3E0S33Z    Introduction of Anti-inflammatory into Epidural Space, Percutaneous Approach 

03.92  
Injection of other agent into spinal canal  

99.23  
Injection of steroid


----------



## mhstrauss

dwaldman said:


> T12-L1 joint is innervated by T11, T12 which are thoracic medial branches. The intervertebral foramen at that level would be T12 and would be the T12 disc. So could report 62310. For ICD-10 you would need to know thoracolumbar, thoracic, or lumbar; whereas, the current code 724.4 is either or can be both.
> 
> 
> 724.4
> Thoracic or lumbosacral neuritis or radiculitis, unspecified
> 
> M54.15  Radiculopathy, thoracolumbar region
> 
> M54.14
> Radiculopathy, thoracic region
> 
> 
> 3E0S33Z    Introduction of Anti-inflammatory into Epidural Space, Percutaneous Approach
> 
> 03.92
> Injection of other agent into spinal canal
> 
> 99.23
> Injection of steroid




Thank you so much; I was hoping you would see this question!  Definitely confirms what my brain was trying to understand.   Have a good weekend!!


----------

