Neurosurgery Coding Alert

Question: Which code should we report for a medial branch block?

New Jersey Subscriber

Answer: Medial branch nerves are the very small nerve branches that communicate spinal facet joint pain. They are synonymous with facet joint nerves, so you should select a code from the 64470-64476 range, depending on the injection site (cervical, thoracic, lumbar, etc.) and the number of levels the physician injects. The parenthetical entry before this code section in CPT specifies that you may report fluoroscopic guidance separately using 76005 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint], including neurolytic agent destruction).
 
Read the physician's documentation carefully to determine how many units to report. Be aware that two medial branch nerves innervate one spinal level, and the code descriptor states "per level" rather than "per injection."
 
Codes 64470-64476 are unilateral. If the physician places injections on both sides of the spine, Medicare prefers that you append modifier -50 (Bilateral procedure) to 64470-64476 to denote the bilateral procedure. Other payers may prefer that you use an "additional level" code (such as +64472, Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, each additional level [list separately in addition to code for primary procedure]), so be sure to ask your insurer for its billing guidelines.