Anesthesia Coding Alert

Question: When our physician performs radiofrequency destruction of the medial branch nerves -- levels L2, L3, L4, L5 and S1 on the left side -- should I bill by level or by the number of injections? Would the total billable levels and/or injections be 3 or 5, and how should I code it? Also, what if the above scenario was a bilateral procedure?

Florida Subscriber

Answer: The key to coding for this procedure is knowing that the destruction of paravertebral facet joint nerves -- also known as medial branch nerves -- is based on the individual nerve, while the injection of paravertebral facet joint/facet joint nerve is based on the facet joint level.

How to code for it: You'll code standard radiofrequency rhizotomy destruction of L2, L3, L4, L5 (L indicating lumbar) and S1 (S indicating sacral) paravertebral facet joint nerves as follows:

Use 64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level), appended with modifier LT (Left side) x 1 followed by +64623 (... lumbar or sacral, each additional level [list separately in addition to code for primary procedure]), again using modifier LT but this time indicating x 4.

Know the difference: You would code injections at those paravertebral facet joint nerves as 64475 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, single level) using modifier LT x 1 and +64476 (... lumbar or sacral, each additional level [list separately in addition to code for primary procedure]) again using modifier LT x 2.

Here's why: Facet joint levels are L3-L4 (L2 and L3 nerves), L4-L5 (L3 and L4 nerves) and L5-S1 (L4, L5 and S1 nerves).

Extra points: When you're coding for a bilateral procedure, the answer depends on the payer's specific policy.

For example: Your physician performs radiofrequency destruction of bilateral lumbar medial branches, which you code as 64622.

You have two coding possibilities. First, you can append this with modifier 50 (Bilateral procedure). You would code this as 64622-50 with one unit of service. Alternatively, you can report each procedure as two separate line items using modifiers RT (Right side) and LT (Left side). You would code this as one line item with 64622-RT and one unit of service and a second line item with 64622-LT and one unit of service.