Neurology & Pain Management Coding Alert

Question:  Our physician coded facet injections for T11/T12, T12/L1, and L1/L2 as thoracic facet injections. What is the correct way to bill this?

Colorado Subscriber

Answer:  You should report:

·         T12-L1 facet injection: 64490 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic; single level), according to CPT^® instructions

·         T11/12: +64491 (…second level [List separately in addition to code for primary procedure])

·         L1-L2: 64493 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral; single level).

Guidance: Use the above codes if the provider used any CT or fluoroscopic image guidance of any type, but do not code the image guidance separately because it’s included in the code. If the provider used ultrasound guidance instead, report Category III codes 0213T (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with ultrasound guidance, cervical or thoracic; single level), +0214T (…second level [List separately in addition to code for primary procedure]), and 0216T (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with ultrasound guidance, lumbar or sacral; single level ).

Also: The multiple procedure discount will apply to 64493 since you’ll be reporting two primary/parent codes. Payers will apply the discount to 64493 because it is the lower RVU code and isn’t an add-on code.