# Help Coding T12-L1 Facet Injections and Diagnosis



## Lamunoz2018 (Sep 28, 2016)

I need clarification on how to code facet joint injections accurately along with diagnosis. I have read previous threads on this forum about this topic, but I am confused on wether to put -59 on the codes or if I need to put modifier -51 or no modifier at all? In the CPT book it states that "For paravertebral facet injection of the T12-L1 joint, or nerves innervating that joint, use 64490". Here is an example of my doctors note:

Procedure Note
Injection, lumbar facet joints, T12-L1, L1-2, L2-3, bilateral, 
fluoroscopic guidance and needle localization
Procedure Details:
Position: prone
Local anesthetic: "No Sting" lidocaine 0.25% solution for skin and subcutaneous infiltration
Needle used: 27ga 3-1/2in spinal needle, at each level
Contrast: omnipaque 0.1cc at each level, (total 3cc with waste), no apparent vascular runoff
Nerves blocked: T11, T12, L1, L2, medial branches at junction of superior articulating process and transverse process, bilateral
Injectate: bupivacaine 0.75%, 0.25cc, at each level
Dye displaced after injection of local anesthetic
Needles removed
Returned to post-op area ambulating 

Would I code this like:
64493 -50       M47.816
64494 -50       M47.816
64490 -50 -59   M47.814 or M47.815

OR

64490 -50       M47.814 or M47.815
64493 -50 -59   M47.816
64494 -50 -59   M47.816


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## Melissa Harris CPC (Sep 29, 2016)

You would bill this as 

64490 50 M47.815
64493 50 59 M47.816
64494 50 59 M47.816

Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management


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## Lamunoz2018 (Sep 30, 2016)

Thank you for your help. I have billed the claim like that before, but I am seeing that Medicare will adjudicate my claim with a modifier -51 instead of -59. Are you seeing that on your claims?


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## KMCFADYEN (Sep 30, 2016)

You should not need to append modifier 59 for the facet codes.
In addition, most Medicare carriers do not want us to send claims with modifier 51 as they will place it accordingly.


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## marvelh (Oct 15, 2016)

The multiple procedure discount (modifier 51) will be automatically applied by Medicare to the 64493-50 code as two parent codes (64490-50 & 64493-50) are being billed.  No multiple procedure discount should be applied to the 64494-50 add-on code.  Agree that no modifier 59 is necessary as there aren't any NCCI bundling edits involved with these codes.


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## Lamunoz2018 (Oct 28, 2016)

Thank you for your help and clarifying that for me.


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