# TFESI/FACET Different Level, Different Side - Same with facets



## kshulund (Oct 2, 2012)

When coding Right L3-4 TFESI with a Left L5-S1 TFESI would you use 64483-RT, 64484-LT -OR- 64483-RT, 64483-LT? 

Same with facets, if it is opposite side and different level - how would you code it? Does anyone have documentation how this should be done by medicare standards?

Thanks!


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## marvelh (Oct 4, 2012)

Bilateral is only to be reported for "mirror" image procedures, i.e. right and left shoulder OR at the same level or right L4-L5 and left L4-L5

Performing a right L4-L5 and left L5-S1 procedures would not be considered to be a bilateral procedure as they are at different levels - just like a right hip and left knee injection would not be considered to be bilateral major joint injections.


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## KDCOWGIRL (Oct 22, 2012)

I agree with the answer and that's how I've always billed - if they were at different levels even if on the other side I would bill the first as 64483 and the add'l  as 64484 add'l level. Now Medicare is asking for refunds for all of these procedures saying that 64484 can't be paid without the required primary code. I did bill the primary code 64483 but on the other side. So are they saying that the right and left each have to have their own primary code? This seems surprising because it's going to cost them more money, not less.                 example TFE L2/3 on the right and TFE L4/5 on the left. I billed 64483 RT and 64484 LT. Now they tell me that 64484 can't be paid because it doesn't have a primary code. So am I supposed to bill 64483 RT and 64483 LT even though they aren't bilateral?


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