# Pain management help



## JEN PROMED (Aug 30, 2010)

I am new to Pain Management billing.  I am billing for the ASC only.  Do I need to specify the nerve root on the UB04 claim form?  How do you bill 64490 64491 and 64492(x2).

Thanks


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## dwaldman (Aug 30, 2010)

With the new codes additional notes are not as needed to explain what was going as they were prior to 2010. With these new codes, they can only be reported with quantity one. The final code for cervical or thoracic blocks states that it includes 3rd or ANY additional levels. So even if the physician performed blocks that correspond to 4 facet levels, you would only have three codes 64490 64491 64492. You would want to determine if this was bilateral or RT/LT and report this on the claim. From a lot of the posts that I see, many coders are billing bilateral procedures in an ASC setting for the facility portion as:

64490-RT
64490-LT
64491-RT
64491-LT
64492-RT
64492-LT


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## JEN PROMED (Sep 16, 2010)

*Pain management*

I am still confused by the facet block injections. Do I bill these in units?  How would I bill
64490, 64491, 64492 (x2) on the right side for c3-4,c4-5,c5-6,c6-7.  Please help, I am new to Pain Management.


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## dwaldman (Sep 17, 2010)

The descriptor says, 3 and any additional levels. So that means with a facet block that is 3 or 4 levels you can only report 64490,64491,64492 with Quantity one.


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## Peter Davidyock (Sep 19, 2010)

I recently had the exact same scenario.
When I questioned the staff about the "x2" i asked if this was a -50.
They said no...same side.
I told them that it would only pay one.
They got indignant and said "IT SAYS ANY ADDITIONAL LEVEL".
Well.....I billed it as they wished, knowing what would happen. And weren't they surprised when it was denied.
I think that the words "any additional level" are giving many the idea that you can bill 
64492 x2, x10, x13 and so on.
When in actuality any additional level is all inclusion to x1


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