Neurosurgery Coding Alert

Question: How does one report for the injections around the hardware with fluoroscopy? Our surgeon did a fluoroscopy to identify the appropriate hardware sites at L4, L5, and S1. Aspiration was negative for blood and cerebrospinal fluid. Marcaine with epinephrine was injected around the hardware.

New York Subscriber

Answer: The type of hardware used is not specified, thereby making it difficult to determine the actual site of injection. As an example, pedicle screws are placed in the superior articular process of the facet. A therapeutic injection may be performed by injecting the facet, supporting use of the 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)-64495 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral; third and any additional level[s] [List separately in addition to code for primary procedure]) series of codes.