Neurosurgery Coding Alert

Keep a count of joints, regardless of the numbers of nerves.

When reporting the paravertebral facet joint nerve injections in 2012, you will no longer be counting nerves that your surgeon targeted. You have so far been reporting injections for every nerve at a single vertebral level. Effective Jan. 1, you'll need to adjust your method to look for the specific anatomical site involved and also the work that your surgeon did. Read on for more on what changes to expect for these injections in 2012: what goes obsolete and what new comes in.

Know the Deletions

Here are four codes that will be deleted in 2012:

• 64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level)
• +64623 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, each additional level [List separately in addition to code for primary procedure])
• 64626 (Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level)
• +64627 (Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, each additional level [List separately in addition to code for primary procedure])

Look at New Codes

You will find four new codes in 2012. These include the following:

• 64633 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; cervical or thoracic, single facet joint)
• +64634 (Destruction by neurolytic agent, paravertebral facet joint nerve [s], with imaging guidance [fluoroscopy or CT]; cervical or thoracic, each additional facet joint [List separately in addition to code for primary procedure])
• 64635 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; lumbar or sacral, single facet joint)
• +64636 (Destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; lumbar or sacral, each additional facet joint [List separately in addition to code for primary procedure])

Don't Separately Report Image Guidance

When reporting neurolysis described by new codes 64633-64636, make sure your surgeon has used and documented the image guidance used to perform the paravertebral facet joint nerve destruction. The codes for 2012 are inclusive of the image guidance, so you do not independently report the fluoroscopy or CT guidance used for the paravertebral nerve localization. "Note that image guidance with either fluoroscopy or CT is both required and is bundled into the new codes," says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison.

Tip: You do not report 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, subarachnoid, or sacroiliac joint], including neurolytic agent destruction) for fluoroscopic guidance and 77012 (Computed tomography guidance for needle placement [eg, biopsy, aspiration, injection, localization device], radiological supervision and interpretation) for CT guidance with 64633-64636.

Note: If your surgeon does the paravertebral facet joint injection without using the image guidance or does not adequately document the imaging guidance, you report an unlisted CPT® code 64999(Unlisted procedure, nervous system).

Report Bilateral Injections: If your surgeon treats both the facet joints at the same vertebral level, you will need to confirm with your payer for reporting the bilateral procedure. According to payer preferences, you may append 50 (Bilateral Procedure) or use RT/LT or use units.

Editor's note: See future issues of Neurosurgery Coding Alert for more analysis of how the 2012 coding updates will affect your coding and billing.