Neurosurgery Coding Alert

Question: What are the correct codes for bilateral paravertebral articular nerve blocks for Medicare and Medicaid claims?

Seattle Subscriber

Answer: Rhonda Petruziello, CPC, reimbursement specialist for neurosurgery at Cleveland Clinic Foundation in Cleveland, says that CPT 2000 has provided new codes for this particular nerve block. The necessary codes can be found in the 64470-64476 range.

CPT 64470 describes an injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level.

These codes are used to describe unilateral procedures and would require a 50 modifier when they are performed bilaterally. The neurosurgeon should check with his or her carriers to be sure of the way they would like this type of charge submitted as it is not uncommon for carrier requirements to differ. For example, Medicare carriers may ask the neurosurgeon to bill it as follows:
64470-50 (quantity of 1)

Another insurer may prefer to see the charges listed as:
64470 (rt.)
64470-50 (lt.)

Remember that 64470 refers to a single level of the vertebrae. Additional levels would be billed using CPT 64472 for cervical or thoracic. However, if the neurosurgeon should need to describe this procedure for the lumbar or sacral level, the neurosurgeon should select 64475 and 64476 for additional levels. According to CPT 2000, For fluoroscopic guidance and localization for needle placement and injection in conjunction with codes 64470-64484, use code 76005).

Finally, these codes should be used for all carriers and not specifically for Medicare and Medicaid.