# Intradiscal injection



## TWIEGANDT (Mar 18, 2010)

Our Pain Mgmt. Specialist just performed a therapeutic injection into a disk.   I have not been able to find a cpt code.  Any suggestions?  Thanks.


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## rkmcoder (Mar 18, 2010)

*Intradiscal injection - need more info*

Please tell us what the operative report says.


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## TWIEGANDT (Mar 18, 2010)

The Op states "A 22-gauge 7-inch spinal needle was inserted into the L5-S1 disk from posterolateral approach.  When the needle was felt to be within the disk space, 1.5 cc of 0.75%bupivacaine was injected and the needle removed."


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## rkmcoder (Mar 18, 2010)

*Good question!*

Pain management injections always target nerves, which are the carriers of the pain.  I do not know what nerves your doc is attacking by injecting the disc.  You may wish to use the 64999 unlisted code, and use 62311 as a like-code for the claim.

Maybe someone else has better advice for you...


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## deb9645 (Mar 18, 2010)

*Billing coding manager*

The office note should tell you what this was for, if the patient was having lower back pain or other kinds of back pain.   This sounds like a trigger point injection not sure with out more information.  But it sounds like trigger point your could use the following 20552 and 20553 if more then one trigger point.  lOOK IN CPT FOR HOW MANY TRIGGER POINTS HE INJECTED


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## rkmcoder (Mar 18, 2010)

*No, not a trigger point*

Trigger point injections are for injections into muscles.  An injection into an intervertebral disk is not an injection into a muscle.


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## dwaldman (Mar 18, 2010)

Use unlisted 22899 w/ compare to 62290


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## dwaldman (Mar 18, 2010)

I stated 22899 but I looked on the internet to try to determine when you should use 22899 versus 64999. I found a medical policy from UHC that has related policies for 22899 as Cervical and Lumbar spine surgery, minimally invasive lumbar spinal fusion, Spinal stabilization and decompression devices, thermal intradiscal procedures for Medicare plans. Whereas for 64999 the two pain procedures that they list or Epiduroscopy for epidural lysis and Functional Anesthetic Discography. 

I guess either one would work


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## rkmcoder (Mar 19, 2010)

*Good rule of thumb*

Use an unlisted code from the same section of the CPT - if you are using a like-code of 62290, then use the unlisted code 64999 - since both are from the Nervous System section of the CPT.  The unlisted code 22899 is from the Musculoskeletal section of the CPT.

Richard Mann, your pain management coder
rkmcoder@yahoo.com


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## TWIEGANDT (Mar 19, 2010)

Thanks for all of your input...it was very helpful.


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