# Pain Management



## lump2009 (Mar 18, 2010)

The dr performed the Rt L2, L3, L4 and L5 for low back pain I billed 64493, 64494, 64495 and 64495 

Another example dr performed Rt L2, L3, L4 and L5 I billed 64493, 64494 and 64495

Last example dr performed Bilateral L4-L5 and L5-S1 bilateral I billed 64493 64494, 64495, 64495

Am I billing these procedures correctly


----------



## hgolfos (Mar 18, 2010)

First example
64493-RT
64494-RT
64495-RT (this code can only be billed once) you are now limited to 3 levels.

second
64493-RT
64494-RT
64495-RT 

Third
64493-50
64494-50

or 
64493-RT
64493-LT
64494-RT
64494-LT

Depending on your carrier.  Medicare requires you to use the 50 mod for bilateral procedures, but some other payers want left and right.

Make sure you're billing your facet joint injections by level not by vertebra.  
for example L4-L5 is one level.  

One other thing I would mention is that none of my payers cover this procedure for back pain as the dx.  I would try to get a more specific dx like spondylosis 721.3 but again, check with your carriers for their specific policies on it.

Hope this helps.


----------

