Anesthesia Coding Alert

Question: Our pain management specialist administered bilateral facet blocks to L3, L4, L5, and S1. How should I bill this to Medicare?

Kentucky Subscriber

Answer: Streamline your coding to:

• 64475 (Injection, anesthetic agent and/or steroid,paravertebral facet joint or facet joint nerve; lumbar or sacral, single level) and modifier 50 (Bilateral procedure) to represent the L4-L5 spinal level innervated by L3 and L4 medial branches

• +64476 (... lumbar or sacral, each additional level [List separately in addition to code for primary procedure]) with modifier 50 for the L5-S1 spinal level innervated by the L4 medial branch and the L5 dorsal ramus.

Why no extras: According to CPT Assistant September 2004, two medial branches block one spinal level, so you code one facet joint spinal level for every two medial branch nerves.

In the past, some providers also thought there was a communicating branch from the S1 spinal nerve to the L5- S1 facet joint. Anatomic research has shown that as untrue. However, if physicians inject the S1 communicating branch, they are still blocking only the L5-S1 facet joint. You don't report additional units of service for the additional injection.

Because of that, your provider blocked only two bilateral spinal levels, based on the information you share.