Anesthesia Coding Alert

Question: Our pain physicians frequently use 64450* (Injection, anesthetic agent; other peripheral nerve or branch). Here is an example on how they use it: 64450 x 4 with sedation. Documentation shows that the physician performed dorsal branch paravertebrals bilaterally at L4-L5 and L5-S1 for a total of four injections. We have been coding this on four lines: 64450 on the first line, and 64450, with modifier -59 (Distinct procedural service) appended, on each subsequent line. Is this correct? Minnesota Subscriber Answer: You should ask the pain management physicians to document in detail the exact structure they are blocking and what agent is being used. For example, what specific nerve is the dorsal branch of the paravertebral?

The spinal nerve gives off its dorsal ramus that supplies motor fibers to and sensory afferents from the posterior spinal muscles and ligaments as well as the zygapophyseal joint. Perhaps what the provider is actually performing is a facet joint nerve injection (64470-64476) or possibly a selective nerve root injection (transforaminal epidural, 64479-64484). Ask the provider to clarify which structure is being blocked.