Anesthesia Coding Alert

CPT codes 64470-+64476 describe unilateral procedures -- the CPT parenthetical note acknowledges there are separate and distinct joints on the right and left sides of the vertebrae. If, however, both the left and right sides are addressed at the same level, CPT and CMS guidelines allow you to report a bilateral procedure.

You may apply modifier 50 (Bilateral procedure) or mods LT (Left side) and RT (Right side), depending upon your payer's preference, to describe bilateral nerve blocks.

Example: If your pain management specialist targets the C3-C4 and C4-C5 joints on both the left and right sides, you may report either 64470-50, 64472-50 (or, for payers preferring anatomical modifiers, 64470-LT, 64470-RT, 64472-LT, and 64472-RT each on a separate line).

Keep in mind: Paravertebral facet joint nerve destruction codes, just like paravertebral facet joint nerve block codes, describe unilateral procedures. You may report bilateral procedures using modifier 50 or modifiers LT and RT, as appropriate for your payer.

Don't Report Destruction & Same-Session Block

Your pain management specialist might provide facet joint injections of an anesthetic, steroid, or both, and destruction at the same location on the same date of service. In this case, you should report only the destruction procedure, according to CPT section guidelines. (Note: You also should check any specific payer instructions).

For instance: A local coverage determination (LCD) for facet joint injections from National Government Services, a Part B Carrier in New York, instructs: "When destruction of the facet joint nerve follows blocking of the same nerve, only the codes for nerve destruction should be billed."

Example: Your pain management specialist performs a therapeutic nerve block for nerves at L2, L3, and L4. Following each injection, she performs RF destruction to the same nerves. The therapeutic nerve injection is typically used to decrease post-destruction side effects. Since destruction includes blocking, you should report only the facet joint nerve destruction, using 64622 for the first level (L2) and two levels of +64623 for additional levels for the L3 and L4 medial branches.