# Coding Help - Today the patient was placed



## mgrimaldi (Mar 3, 2014)

I need help coding the following procedure.

PROCEDURE:  Today the patient was placed in prone posture on the fluoroscopy table, and the head and neck prepped in customary sterile fashion. I carefully palpated area of greatest pain on right and identified it as being the occipital emergence on right beneath nuchal ridge and at the C1-2 inner space.  I looked at where the shunt appeared to be placed and noted that it does have a loop or curl at C1-2.  It appears to be within the musculature.  I carefully placed a 25-gauge needle at this point under fluoroscopic guidance to make sure that the shunt itself was not contacted.  I injected 1 cc of Omnipaque dye superficially and deeply to mark the area where the patient felt needle placement had caused the greatest pain.  After marking these points, I injected lidocaine 4%, Marcaine 0.75%, and Depo-Medrol 40 mg, 3 cc total divided between the points.  Needles were withdrawn.  

Patient is having pain 6 month's post op for shunt placement due to increased cranial pressure.  Provider coded as a cervical facet 64490.  I am doubting that this is accurate. 

Any takers out there?


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## dwaldman (Mar 5, 2014)

What is the indication for the procedure? Is one thing that could be review, And confirming where the needle is being placed or what is being targeted to relieve pain in this area.

Below is from AMA CPT Assistant from 2010 that does support for C1-C2 to use 64490. 

December 2010 page 13

Surgery: Nervous System, 64490 (Q&A) 

Question: What is the appropriate code to report for an intra-articular atlanto-occipital joint injection (AO or C0-C1 joint) or an intra-articular atlanto-axial joint injection (AA or C1-C2 joint)? Marvel J Hammer RN CPC CCS-P PCS ACS-PM CHCO, Denver, CO

Answer: It is appropriate to report code 64490, Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level, for either atlanto-occipital or atlanto-axial joint injection. The atlanto-occipital joint is between the base of the skull and first vertebrae of the cervical spine. Injections into the atlanto-occipital joint may be used to treat pain at the back of the head.


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