# Billing question-pain mgmt



## kpetkis (Mar 27, 2009)

Question- I know the codes to apply but I would like your interpretation of what the doctor wrote. This is pain mgmt.

"The bilateral pedicles from C5-7 were identified under fluoroscopic guidance. A 22g spinal needle was advanced until bony contact with the pedicle was made. A solution containing 1 ml of 1% lidocaine mixed with 2 mg of Dexamethasome was injected at each medial branch."

The pedicle is on the vertebra and the medical branches are in the facet joint. There are 4 facet joints associated with each vertebra below the level of C2 and above S1. Since this provider is referring to the pedicles, is he referring to the vertebra and is therefore, injecting the facet joints bilateraly between C5 and C6 and C6 and C7? Meaning 4 injections? 

Or is he also injecting the facet joints bilaterally between C5 and C4 and C7 and L1? Meaning 8 injections?
Thanks, 
kathy


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## jdrueppel (Mar 29, 2009)

I'm a little confused by your post because you indicate S1 level which I think you meant T1???
Based on the documentation of the service which indicates bilateral C5-C7 I'm seeing 
64470-50 (C5-6)
64472-50 (C6-7)
77003-26 (If billing professional component only)

I would confirm with the provider before coding for C7-T1 level.

Depending on whom your payer is you may need to separate *each* line of service and forgo the -50 modifiers for the LT and RT modifiers.

Julie, CPC


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