Neurology & Pain Management Coding Alert

Question: How do I code a facet joint injection into the cervical spine for a patient who is under anesthesia? The physician performed the injection, but not the anesthesia. Would he be affected by the anesthesiologists billing (eg, would the insurer consider this to be part of pain management)?

Indiana Subscriber

Answer: Code 64470 (injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level) should be billed regardless of whether it is performed while the patient is under anesthesia or not. If, however, the neurologist had difficulty with the procedure, and could validate that there was an increased work level of approximately 30 to 50 percent, you might consider submitting the documentation with a -22 modifier (unusual procedural services) and asking for additional reimbursement. But, just because the procedure is performed under anesthesia does not justify more work, and thus a higher payment. Insurance carriers are looking for a significant increase in the neurologists actual effort to justify the use of -22.