# L4-L5 Facet joint injection (multiple)



## beach59 (Jul 25, 2013)

One of our providers did a lumbar facet injection, bilateral, of one level, L4-L5. Our billing department used CPT 64493 for the first site and 64493-50 for the second site. Reading the report, it looks to me as though there were two injections to L4 (each side) and two injections to L5. I am trying to figure out if this is the correct way to code this procedure. Report reads:

The L4-L5 facet joints were localized under CT. Patient's skin marked posterior to the joints. Skin prepped and draped in the usual sterile manner.

Local anesthesia was obtained using subq infiltration of 1 ml of 1% lidocaine buffered with sodium bicarbonate. 

Using intermittent CT fluoroscopic guidance, 22-gauge needles were placed into the L4-L5 facets joints.

20 mg of Depo-Medrol and 2 ml of 0.25% Marcaine was injected into *each joint*. 


Is 64493, 64493-50 correct or should it be 64493-50 twice or should it be something entirely different? Help?! Has anyone seen this before? This was done in the hospital outpatient setting. Not sure if that makes a difference


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## aaron.lucas (Jul 25, 2013)

Well the joints would be referenced by the two levels that are connected, in this example L4-L5.  This constitutes one joint, and therefore one "level" of injection.  Since it's bilateral it should be billed on one line with modifier -50, no additional lines.  Unless of course you're dealing with a payor that wants LT/RT, which isn't outside the realm of possibility.  In that case you would bill two lines, one with each side.  Hope that helps!


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## chembree (Jul 25, 2013)

aaron.lucas said:


> Well the joints would be referenced by the two levels that are connected, in this example L4-L5.  This constitutes one joint, and therefore one "level" of injection.  Since it's bilateral it should be billed on one line with modifier -50, no additional lines.  Unless of course you're dealing with a payor that wants LT/RT, which isn't outside the realm of possibility.  In that case you would bill two lines, one with each side.  Hope that helps!



I completely agree. There was a recent ACR article about how Medicare instructs us to use modifier 50. http://www.acr.org/Advocacy/Economi...-List/2013/Jan-Feb-2013/Bilateral-Surgery-MUE

Also, had multiple levels been injected there are add-on codes to report the additional levels.


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