# Spine hardware injection



## dhunter (Dec 30, 2009)

Hi, Need some help on coding for our pain management doctor. He did a bilateral L4, L5 and S1 Hardware injection with Corticosteroid.

Patient placed prone on fluoroscopy table. Light conscious sedation was provided. The lumbosacral area was prepped and draped in the usual matter.
Landmarks were indentified using C-arm fluoroscopic image intensifier. The overlying skin and soft tissue structures were anesthetized with 1% buffered Lidocaine. A 25 gauge spinal needle was advanced to approximate the LEFT L4,L5 and S1 target screw heads. Isovue 300 contrast was thereafter injected to confirm placement and delivery of the injected solution to the appropriate target: there was no evidence of intravascular spread. 10mg Methylprednisolone Acetate PF + 2cc 0.5% Marcaine without epinephrine PF was thereafter slowly injected at each level without complications.
The above procedure was repeated at the right L4,L5,S1 hardware block.

Any help on coding this would be most helpful.
Thanks,
Dawn


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## Walker22 (Dec 30, 2009)

Wow.. tough one. I'd say 20552 covers the whole thing, but the reimbursement won't be very much. Anyone else have anything better?


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## karenwebb (Dec 30, 2009)

*refer to webpage below*

you aren't the only person with this coding issue 
http://preview.aapc.com/memberarea/forums/showthread.php?p=86435


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## vanessa10 (Jan 7, 2010)

A hardware injection is neither done in the joint or the muscle.  It is merely in the "affected area" via flouroscopy.  I have always billed them as 64472 for cervical and 64475 for lumbar.  64450 for all other areas.  Billed it that way for years and have gotten paid with report.


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## brockorama01 (Jan 15, 2010)

Here's my offering:
I'm not wild about billing medical branch/facet injections 64475's (64490's) for hardware injections.

You need more info.

Think of it this way.  You are not therapuetically injecting screws.  You are injecting some nerve.  Have physician try to explain what nerves.  It might actually be medial branch nerves.  If not, 64450, Other Peripheral Nerve, x 3?

Brock Berta CPC


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## coderguy1939 (Jan 15, 2010)

If this is for pain management for spinal hardware, Anesthesia & Pain Management Coding Alert, 2008, Vol. 10, Number 11, recommends that 22899 or 64999 should be used unless otherwise indicated by the carrier.


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