Anesthesia Coding Alert

Question: The pain management doctor administered facet joint injections at the T11-L2 levels. Should we code this as both thoracic and lumbar facet injections, or only report the thoracic injection codes?

Mississippi Subscriber

Answer: Your physician injected a total of three spinal levels: T11-T12, T12-L1, and L1-L2. For the thoracic facet joint injection (T11-T12), report 64490 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic; single level).

Per the CPT parenthetical note preceding 64490, report 64493 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [for nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral; single level) for the T12-L1 injection. For the L1-L2 facet injection, use the lumbar/sacral add-on code: +64494 (... second level [List separately in addition to code for primary procedure]).

Don't miss: Many payers, including Medicare, follow a reduced fee policy for multiple procedures performed during the same operative session. Remember in this particular scenario, the multiple procedure reduction would apply to 64493 as it has a lower relative value units valuation compared to 64490. The multiple procedure reduction does not apply to add-on code +64494, however. You should expect this code to be reimbursed at 100 percent.

Be sure to include the appropriate diagnoses for each injection. These can include, for example, 724.1 (Pain in thoracic spine), 724.2 (Lumbago), 721.2 (Thoracic spondylosis without myelopathy), or 721.3 (Lumbosacral spondylosis without myelopathy).