Anesthesia Coding Alert

Carefully choose 64470 or 64626 based on MD's documentation.Facet joint injections are anything but a piece of cake for coders. There's a difference between a nerve block and nerve destruction. There's also a difference in the definition of the term "level" for nerve blocks or nerve destruction in the CPT code descriptions. Refresh your memory on how to code these two tricky procedures to ensure your pain management specialist is getting her due.Beware Miscounting Nerves vs. JointsA single level for paravertebral facet joint injections deals with the interspace -- or "joint" -- between two vertebrae, so one level of block will actually involve an injection into the joint itself, or two injections blocking each of the paravertebral facet joint (medial branch) nerves that provide sensory information from the joint back to the spine.Example 1: Your pain management specialist performs diagnostic nerve blocks of the C3 and C4 medial branches (blocking the C3-C4 facet joint) -- that is only one level. You should report only 64470 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level) for those injections, says pain management specialist Richard Kennedy, MD.Example 2: Now let's say your pain management specialist performs injections of the C3, C4, and C5 medial branches. Now she is addressing three nerves but only two "joints;" that is, C3-C4 and C4-C5.  You would count each joint as one level, so use +64472 (. . . cervical or thoracic, each additional level [List separately in addition to code for primary procedure]) for the second injection.Pop quiz: Test your nerve block counting skills with this quick story problem: Your pain management specialist hands you documentation that shows she blocked the L1 through L4 medial branches on a patient. How many levels should you code for the procedure?Answer: Three. Your pain management specialist is addressing four nerves: L1, L2, L3, and L4. However, since you count only the interspaces between the vertebrae, you would code only three levels: one for the joint between L2-L3, a second for the joint between L3-L4, and your third for the joint between L4-L5. So you would report 64475 first, and add two units of +64476. You many have noticed that the nomenclature from the nerve to facet joint level changed in the example. For instance, the L1 and L2 medial branches provide the sensory innervation from the L2-L3 facet joint level. This is because there is a C8 spinal nerve but no C8 vertebrae. So in the cervical region, the medial branches "match" the facet joint level " that is, C3 and C4 for the C3-C4 facet joint level. On the other hand, the T3 and T4 medial branches provide innervation to the T2-T3 facet joint [...]