Anesthesia Coding Alert

Question: Our physician performs paravertebral facet joint injections. Would you clarify how to code blocks to this joint versus nerve destruction?

Kentucky Subscriber Answer: Your tactic for reporting these injections depends on the service your physician provides.

Code injections into the paravertebral facet joint or at the paravertebral facet joint nerve according to facet joint level (for example, L3-L4 equals one code). Providers often need to inject two paravertebral facet joint nerves to block one facet joint level.

If your physician performs neurolytic destruction of the paravertebral facet joint nerve, you should code per nerve. For example, you should report two codes for L3 and L4 paravertebral facet joint nerve radiofrequency destruction.

Two-nerve exception: Anatomic research has found that the L5-S1 facet joint level received innervation from three nerves (the L4, L5 and S1 paravertebral facet joint nerve). If your physician administers a block to each of these nerves, you still only report the block once with 64475 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, single level).

If he destroys the three nerves, however, you report 64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level) for the first nerve and +64623 (... lumbar or sacral, each additional level [list separately in addition to code for primary procedure]) for each additional nerve. Answers to You Be the Coder and Reader Questions were provided by Scott Groudine, MD, an Albany, N.Y., anesthesiologist; Barbara J. Johnson, CPC, MPC, owner of Real Code Inc. in Moreno Valley, Calif.; and Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.