Neurology & Pain Management Coding Alert

Question: My physician injected an anesthetic agent into the nerves nnervating the patient’s sacroiliac joint. He injected five nerves and used computed tomography (CT) guidance to perform this procedure. Which CPT^® code should I report?

Tennessee Subscriber

Answer: You should report 64451 (Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)) for this procedure.

Don’t miss: With 64451, you should report one unit for any number of nerves innervating the sacroiliac joint inject, regardless of the number of injections. Also, since imaging guidance is included is an inclusive component of 64451, you cannot report the CT guidance separately. This is a different procedure from injecting the sacroiliac joint itself, which is reported with code 27096 (Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed), which requires image guidance and includes arthrogram, when performed.

Caution: The 64451 code is new for 2020. In previous years, you’d have reported 64450 (Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch) to report this injection. You should be all set to file with 64451, but if you haven’t used it yet, consider contacting the payer to ensure that they are accepting 64451 for this service. (All payers should be accepting this code by now, but strange things happen sometimes.)

Also, you should never report 64451 in conjunction with any of the following codes, according to CPT^®:

• 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) through +64495 (… third and any additional level(s) (List separately in addition to code for primary procedure));
• +77002 (Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure)) and +77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (List separately in addition to code for primary procedure));
• 77012 (Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation); and
• +95873 (Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)) and +95874 (Needle electromyography for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)).