Anesthesia Coding Alert

Question: We are having trouble being reimbursed for 64620 (Destruction by neurolytic agent, intercostal nerve) when it is performed for multiple levels. The physician injected at T5, T6, T7 and T8, and indicated a diagnosis of thoracic pain and intercostals neuralgia. How should we code this for proper reimbursement?

New Jersey Subscriber

Answer: Initially, you should consider whether the physician injected the intercostal nerve or the thoracic region (the posterior or back region). A neurolytic injection is a fairly radical treatment for a simple backache. If the physician dictated that he performed a neurolytic injection, this should be a case of chronic pain that other treatments failed to relieve. If he performed a back injection, you should try coding with 64626 (Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level) or 64627 ( cervical or thoracic, each additional level [list separately in addition to code for primary procedure]).

If the physician only performed an intercostal injection from the front, use 64620 and append modifier -51 (Multiple procedures) or -59 (Distinct procedural service) for each injection performed, depending on whether the same incision was used for all procedures (in which case you would use -51) or whether a separate incision was made (which would be -59).