Neurology & Pain Management Coding Alert

Count levels treated, not injections, for 64470-64476

For facet joint injections (64470-64476), you should report only a single unit of service for multiple injections at the same spinal level - unless the neurologist provides the injections bilaterally.

For bilateral injections, you may append modifier -50 (Bilateral procedure), but you must be careful not to exceed payer utilization guidelines. 1. Choose 64472, 64476 for Additional Levels When reporting facet joint injections, you should choose either 64470 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level) or 64475 (... lumbar or sacral, single level), depending on the area of the spine level the neurologist treats.
 
For each additional level the neurologist injects in the cervical or thoracic area, report +64472 (... cervical or thoracic, each additional level [list separately in addition to code for primary procedure]). For each additional level the neurologist injects in the lumbar or sacral area, turn instead to +64476 (... lumbar or sacral, each additional level [list separately in addition to code for primary procedure]).
 
Although the descriptors for 64470-64476 specify spinal "levels," the neurologist actually targets facet joint injections at the space between vertebrae (in other words, the interspace), not at the vertebrae themselves, says Susan Allen, CPC, CCS-P, coding manager and compliance officer for Florida Spine Institute in Clearwater, Fla. If the neurologist documents, for instance, "Facet joint injection at C4/C5," this represents a single injection to the interspace between the forth and fifth cervical vertebrae, not two separate injections at the fourth and fifth cervical vertebrae.

Example: The neurologist provides facet joint injections at L1/L2 and L2/L3. In this case, you would report 64475 (for the initial lumbar "level") and 64476 (for the injection at an additional lumbar level). 2. Same Level, Same Side Injections = 1 'Unit' If the neurologist provides more than one injection at the same spinal level, and on the same side of the spine, you may only report a single unit of service for most payers, says Trish Bukauskas-Vollmer, CPC, owner of TB Consulting in Myrtle Beach, S.C.

Example: The neurologist must administer two injections to block the median branch nerve inside the joint because one branch of the nerve sits at the top of the facet joint and a second branch sits at the bottom.

Some coders mistakenly believe that because the neurologist must administer two injections, they may bill for two separate injections. This is not the case: The descriptor for 64470-64476 specifically notes "single level," not "per injection."
 
Two injections for a nerve block at T1/T2 and two more at T2/T3 equals only two levels, although the physician administered a total of four injections. Therefore, you should report 64470, 64472. 3. Same Level, Different Side [...]