# 64483 &64484



## espressofa99

If you have the following operating report:
Operation:	Bilateral L4, L5, S1 selective nerve root block.
OPERATIVE PROCEDURE:
The patient was taken to the operating room.  He was placed in the prone position.  He received IV sedation from the anesthesia department.  Fluoroscopic guidance was utilized to advance the 5 inch 22 gauge spinal needle into the bilateral L4 L5 and L5 S1 and S1 neuroforamen.  Needle placement was confirmed in AP, oblique, and lateral views.  No blood, CSF, or paraesthesias were noted.  Omnipaque 240 and 1 cc was injected at each level, which showed good epidural spread and outlining the exiting nerve root.  No vascular uptake was noted.  Kenalog 10 mg and 1 cc of lidocaine was injected at each level.  The patient tolerated the procedure well.  The patient will follow up in two weeks.

The office coded, 64483-50, 64484-50 x2, 77003-26

does that S1 neuroforamen count as another level to justify the 64484-50 x2?

Thanks for your help!


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## dwaldman

64483-50
64484-50
64484-50
Below are 2011 descriptors for lumbar/sacral transforaminal epidural injections which have been revised and effective for dates of service on or after January 1,2011_____________________________________________________________
Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level 

Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional level (List separately in addition to code for primary procedure)  
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Due to the fact "with image guidance" is in the descriptor, 77003 would not be separately reported. The descriptor includes "sacral" and from previous posts I have seen S1 can be separately reported distinct from the L5 foramen and L4 foramen. I would watch quantity 2 with the 50 modifier, Medicare for outpatient hospitals has OCE edit that states quantity one has to be used with modifier 50, on the professional side it can also be difficult for the carrier's claim processing software to think 1 addl level 150%, 1 level addl 150% when it has to broken out from a single line.

Below is the section notes that Ignenix's Encoder pro provides:
________________________________________________________
Section Notes - 64479-64484 Transforaminal Injection - (64479-64484) 
 Transforaminal Injection

INCLUDES: Imaging guidance (fluoroscopy or CT) and contrast injection

EXCLUDES: Epidural or subarachnoid injection (62310-62319)

Nerve destruction (62280-62282, 64600-64681)  
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## espressofa99

Thanks for answering!

If the procedure was done in 2010, did the codes 64483 & 64484 include fluoscopy?


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## dwaldman

77003 was separately reportable when utilized to perform 64479-64484 prior to January 1, 2011. 

I checked the NCCI edits current verison 17.0 and noticed they decided to make 77003 a column 2 code to column one codes 64479-64480.


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