Anesthesia Coding Alert

Question: We have recently begun performing spinous process injections, and are not sure which CPT code to use. Should we use the unlisted-procedure code 90799 (Unlisted therapeutic, prophylactic or diagnostic injection), or is something else more appropriate?

Maryland Subscriber

Answer: First, you should ask the provider to clarify what anatomic structure is being injected, and with what medication. The spinous process of the vertebrae is bone, so you must learn whether the provider is injecting the ligaments attached to the spinous process rather than the bone itself. If so, the appropriate code is 20550* (Injection; tendon sheath, ligament, ganglion cyst). If the provider is injecting the transverse process area of the vertebrae but calling it the spinous process, one of the facet joint injection codes from the series 64470-64476 would apply, depending on the drug injected and the level of the spine treated.

Code 90799 would not reimburse the provider adequately for the services, even if you append modifier -22 (Unusual procedural services). If you decide to use an unlisted-procedure code, 64999 (Unlisted procedure, nervous system) would be a better option. Although its descriptor is for the nervous system, it includes the vertebral regions the injections are for.