# 64483 & 64493 on same day?



## BFAITHFUL (Mar 4, 2010)

can I bill both cpt 64483 and 64493 on same day.   There are no bundling edits according to CCI, but Im still not sure if they can be billed together. Although this is not for a Medicare patient.   The only article I've found so far is Medicare's LCD coverage stating it is not medically necessary to perform both a transforaminal and a facet joint injection during the same session.  Does anyone have some info. on this?   Thanks


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## Walker22 (Mar 5, 2010)

The two procedures should not be performed together at the same time because 64493 is a diagnostic procedure and the 64483 may interfere with the results. How do you know which one gave the pain relief if you do both at the same time? Those two codes are the backbone of my pain management practice and we NEVER perform them at the same time!


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## brockorama01 (Mar 5, 2010)

I concur.  64483 & 64493 is not appropriate.  It's so "out there" I am doubtful about what your doc actually did.  Verify the op note.  Did he really do two separate injections or is he/she just trying to claim billing both codes by one giant bolus of steroid?  Either way, discourage this in the future.


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## BFAITHFUL (Mar 5, 2010)

here is the op report:


DX:  low back pain  (724.2), left lower extremity pain (729.5) , lumbar facet arthropathy (721.3)    

The OEC 9900 Elite fluoroscope was brought into view and the vertebral bodies at L4-L5 and L5-S1 levels were identified utilizing 35 degrees of left lateral rotation.  The facet joints were opened maximally.  The laser pointer was placed on the corresponding skin sites.  After adequate anesthesia was obtained through the skin utilizing 1cc of 1% bicarbonated lidocaine, 22 hauge spinal needles 5 inches in length were passed through the skin, subcutaneous tissue, and negotiated into the facet joints with great care.  The stylets were removed.  Aspiration revealed no blood, pain, paresthesias, urine, or other bodily contents.  Omnipaque 240 was injected to peform an arthrogram, which was within normal limits.  At this point, 20cc of Celestone and 2cc of Marcaine 5% were injected.  The needles were removed. 

Then, attention was turned to the L5-S1 neural foramen.  It wasopened maximally utilizing the OEC 9900 Elite flurosocope with 35 degrees of left cephalic tilt.  Local skin anesthesia was obtained with 1cc of 1% lidocaine and the 22 gauge spinal needle, 5 inches in length was passed down the laser point and negotiated into the left L5-S2 foramen.  Neurograms were placed after the stylet was removed, which revealed ona spiration, no blood, pain paresthesias, urine or other bodily contents.  Then 1cc of Omnipaque 240 was injected and the neurogram was adequate.  There was no intravenous or intravascular flow,  C-betamethasone 6mg, 35mcg of fentanyl and 2cc of 0.5% Marcaine were injected at this point.  The needle was removed.  antibiotic ointment and band aids were placed over the site of this needle insertion.

What do you guys think?


Which also leads me to another question can 62311 & 64483 be billed together,  I read an article from the Coding Institute that says we can using modifier 59 on 64483,   (for example, let's say doc did caudal epidural & transforaminal at L3-L4


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## BFAITHFUL (Mar 5, 2010)

sorry, I meant negotiated into the "L5-S1 not L5-S2"


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## michii21 (Mar 9, 2010)

was the pt taken off an anticoagulant,,,you can justify doing two different types of injection if the pt was taken off an anticoagulant in order to treat the pt. v58.61,,,also if two seperate independent levels were perfromed then you could add the 59 mod


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## BFAITHFUL (Mar 9, 2010)

no patient not on any coagulant?  the facet joint was at L4-L5 & L5-S1 and the 64483 was at L5-S1.    Op report is posted above.


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## Walker22 (Mar 9, 2010)

It has been my experience that it doesn't matter if the patient was taken off anti-coagulents just for the procedure or not, they still will not pay for both at the same time. Why would you do a diagnostic procedure, and then turn around and do another procedure that would skew the results?


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## hgolfos (Mar 9, 2010)

64483 and 64493 are used to treat different types of pain, from my experience.  64493 is used to treat facet arthropathy, though some carriers don't recognize it, all of those which I file to do accept it.  721.3.  The transforaminal injection is to treat pain caused by radiculopathy, stenosis, disc disease or HNP (I don't see a diagnosis in your dictation to support the transforaminal) I believe that there was another post, responded to by Marvel on this same subject, she gave some very helpful info on it.


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## spebuck (Mar 10, 2010)

We've been having the same issues even though the injections are at different levels for different dx-ie;64483 for 724.02 @L4-5 & 64493-59 for 721.3 @L5-S1. I've been appealing w/copies of the op-note with some luck.


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## BFAITHFUL (Mar 10, 2010)

hgolfos, but also 64483 is to treat extremity pain/pain in limbs as well, 729.5 it's even listed in Medicare's LCD as a valid dx to prove medical necessity


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## hgolfos (Mar 11, 2010)

BFaithful, 

Sorry, all our pain clients are in Georgia and per Georgia MC's LCD 729.5 is not listed as a covered dx.


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## BFAITHFUL (Mar 11, 2010)

Ok, I understand


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