Anesthesia Coding Alert

Question: Our physician billed +64476 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, each additional level [list separately in addition to code for primary procedure]) with modifier -51 (Multiple procedures) for a two-level facet injection of the L6 and L7 spine. Is this correct? Washington Subscriber Answer: No, this is not the way to code this procedure. First, 64476 is an add-on code (noted in CPT by a "+" in the margin and the phrase "each additional" in the descriptor), which means it must be used with the corresponding primary code. Second, modifier -51 is not used with add-on codes, per CPT guidelines. So what are the correct codes? Your first step is to determine how many levels the physician injected and verify where they were. There are no L6 or L7 vertebrae, so check this with the physician so you can code the levels correctly. If the injections were in the lumbar or sacral region, use 64475 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, single level) for the first injection with 64476 for additional injections. If it was in the cervical/thoracic region, use 64470 ( cervical or thoracic, single level) and +64472 ( cervical or thoracic, each additional level [list separately in addition to code for primary procedure]). Many carriers are notorious for missing codes and denying duplicate services. Read the operative report carefully to be sure the physician documented everything you're coding. Either send a copy of the operative report with the claim or have one handy in case the carrier questions the claim. Answers to You Be the Coder and Reader Questions were reviewed by Jann Lienhard, CPC, an anesthesia and pain management coding consultant in New Jersey.