# Transforaminal epidural steroid injection L5-S1 AND S1 nerve root



## laureninstlouis (Jun 5, 2015)

Plan:  We will proceed today with transforaminal injection.  I have recommended in addition to the right L5-S1, addition of the S1 nerve root to get better spread of the medication. 

Procedure:  Transforaminal epidural steroid injection right L5-S1, and S1.

"Attention was then turned to the S1 neural foramen.  Again entry point for the needle was identified over the superolateral border of the S1 neural foramen.  Skin and subcutaneous tissues were infiltrated with 1% lidocaine.  A 22-gauge needle was then advanced to contact the bone.  The needle was then walked off inferomedially."

64483-RT for the L5-S1 injection, but I don't know what to do with the S1 nerve root part.  64483/84 require a RT/LT/50 modifier, don't they?  Would the S1 nerve root maybe not be a transforaminal injection?  Maybe 62311 for that part?

I'm very new to coding and new to spinal injections in particular, so please forgive me if I'm asking dumb questions!  Thanks in advance.


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## DIANA0331 (Jun 5, 2015)

64483 RT
64484 RT

and then depending on the situation CPT CODE 72275 x 26 might apply

Per AMA's CPT Assistant, there are certain elements that should be documented that go beyond the flow of the contrast in order for the physician to correctly report 72275. These elements should be written in a report that is separately distinguishable from the epidural injection results and subsequent results. Without these elements, only the fluoroscopic part of the procedure (77003) can be reported.

Hope that helps


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## pappash (Dec 17, 2015)

Regarding 64484, Why would that be billed?  S1 is part of the L5-S1 level, and wouldn't 64483 cover that level?  Just wondering if I am missing something where S1 is considered a separate level.  Thanks!
Per CPT Assistant - Feb 2005 
Question
When reporting add-on codes 64480 and 64484, is it appropriate to report these codes more than one time if multiple injections are performed at a particular spinal level? 
AMA Comment
From a CPT coding perspective, codes 64480 and 64484 are reported once regardless of the number of injections performed at a particular spinal level.


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