Neurology & Pain Management Coding Alert

Question:  Our pain management specialist performed the following procedures:

• RT C2-C3, RT C3-C4 , RT atlanto-occipital joint and RT atlanto-axial joint injections

This was a total of four injections. I get confused with how to code the AO and AA joints because of the location. Can you please help?

North Dakota Subscriber

Answer:  First, look at which joints were involved with each injection:

• Occipito-atlantal joint/Atlanto-occipital joint (articulation between the atlas and the occipital bone) is the C0-C1 
• Atlanto-axial joint is the C1-C2
• C2-C3
• C3-C4.

You’re dealing with four paravertebral facet joint levels for injections. Report the encounter as:

• 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) for C0-C1
  
• + 64491 (…second level [List separately in addition to code for primary procedure]) for C1-C2
  
• +64492 (…third and any additional level[s] [List separately in addition to code for primary procedure]) for the C2-C3 and C3-C4 injections. Remember, since +64492 specifies “third and each additional” level, you should only bill with one unit of service for both the C2-C3 and C3-C4 injections.