Neurology & Pain Management Coding Alert

Question: Our pain management specialist performed a left medial branch block at the L5 vertebrae and L5 dorsal ramus, plus a Bertolotti joint injection. The provider recommended that we report 64493-LT and 64494-LT. I don't think this is correct since the Bertolotti joint is a "pseudo" joint. What is the best choice?

Answer: You are correct in stating that the Bertolotti joint isn't a true paravertebral facet joint " it's a congenital anomaly when the transverse process of the L5 vertebra becomes larger than normal on one or both sides and fuses to the sacrum, ilium, or both. Check with your physician to determine whether 20605 (Arthrocentesis, aspiration and/or injection; intermediate joint or bursa [eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa]) or 22899 (Unlisted procedure, spine) more accurately describes the Bertolotti joint injection. Remember to include 756.15 (Fusion of spine [vertebra], congenital) as the diagnosis for Bertolotti syndrome.

Lumbar choice: Report each lumbar injection with 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) and append modifier LT (Left side).