# Does cpt code 64450 include cpt s0020?



## micki127 (Apr 23, 2014)

Hello,

Can someone tell me if CPT code 64450 include CPT S0020?  Can you bill out xylocaine with the nerve block?

Thank you for any advice in advance.


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## Melissa Harris CPC (Apr 23, 2014)

You can bill it.  Some carriers include it in the procedure. Check with the carrier to see.


Melissa Harris, CPC
The Albany and Saratoga Centers of Pain Management


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## Limbanidd2012@gmail.com  (Sep 4, 2019)

Hi!

Please help me for below procedure.

diagnostic bilateral lumbar facet joint injections at L2-3, L3-4, and L4-5 with fluoroscopic guidance.  CPT codes are 64493–50 and 64494–50.

the patient was taken to the operating room and placed on the operating room table in the prone position.  All pressure points were well padded.  A timeout was performed prior to the procedure and there was agreement between the OR staff and the patient.  The patient was monitored and sedated by members of the anesthesia department.

Under fluoroscopic imaging in the PA and oblique views, the facets at the appropriate levels were identified and the target sites over each facet, more marked with a marking pen on the skin.  The back was prepped with Hibiclens and draped in sterile fashion.  The skin over each target site was anesthetized with Marcaine 0.25% equal to 2 cc Then each level Center with a 22-gauge 7 inch block needle.  The needle tips were guided to the junction of the transverse process and the pedicle of the appropriate facets.

aspiration was negative for blood and CSF.

Then, each level was injected with Marcaine 0.25% equal to 1 cc and lidocaine 1% 

 For lidocaine and marcaine we dont get payment.  lidocaine J2001(for IV) which is not billable and second one is marcaine which is also not billable for medicare. Kindly provide any suggestion. Shall we bill only 64493 and 64494 without any J code which is payable or not?


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## Melissa Harris CPC (Sep 4, 2019)

Firstly I would also bill 64494 - 50 as 3  facet levels were injected.   

Injectables are not covered in the ASC.  In office you can bill Marcaine but not all insurances cover it.

Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management


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## CodingKing (Sep 4, 2019)

Lidocaine is a part of the practice expense RVU for all injection procedures in a non-facility place of service (11 for example), whether the payer catches it or not is another issue.
For facility place of service its facility expense and not professional.
J2001 is not for injected lidocaine. Its for infusion that is typically used to treat cardiac arrhythmia or chronic pain, not when used an a local/regional anesthestic


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