Neurology & Pain Management Coding Alert

Question: How can we report facet injections? Our provider injected at three levels of the cervical spine. Do we bill 64490, 64491, and 64492, or do we just bill 64492? Please help.

Michigan Subscriber

Answer: You need to confirm what region of the spinal cord was injected. Assuming that your provider injected in the thoracic or cervical level, your choice of codes is correct. You report each code only once for one joint. For the first injection, submit 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 the second injection, submit 64491 (… second level [List separately in addition to code for primary procedure]). For the injection at the third level and onwards within the same region, you report code +64492 (… third and any additional level[s] [List separately in addition to code for primary procedure]).

Note that you report +64492 only once even if injections are given at multiple additional levels as the descriptor of the code says ‘third and any additional levels.’ Since +64492 is an add-on code, you cannot report it as stand-alone code. You must also bill for the primary / “parent” CPT^® code.