Anesthesia Coding Alert

Question: What level would you consider T12-L1: thoracic or lumbar? I'm specifically looking for advice on how to code a T12-L1 and L1-L2 paravertebral nerve root injection.

Texas Subscriber

Answer: Some coders consider T12-L1 to be either thoracic or lumbar, but when you look at the nerve and vertebral structure you see that the only nerve to administer a block to in the T12-L1 space is the 12th thoracic nerve (T12). That makes this a thoracic nerve block that should be coded with 64470 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level). (Anatomy notwithstanding, most coders generally consider T12-L1 as thoracic from an anesthesia perspective since the code for thoracic injections has two more base units than the one for lumbar injections, and we are allowed to file with the higher base code.)

Use code 64475 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, single level) for the initial L1-L2 paravertebral nerve root injection. Use code +64476 ( lumbar or sacral, each additional level [list separately in addition to code for primary procedure]) for each additional level.