Neurosurgery Coding Alert

Question: Our physician administers paravertebral facet joint injections at the levels: L1, L2, L3, L4, and L5.How can we report these injections? Can we report add-on codes +64494 and +64495 with 64493?

Nebraska Subscriber

Answer: Adopt a stepwise approach to avoid missing any level for the injections that your physician administered.

Step 1: For injections at the initial L1-L2 facet joint level, you submit the primary code 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). 

Step 2: You then add +64494 (…second level [List separately in addition to code for primary procedure]) for the nerve injections for the second L2-L3 facet joint level. 

Step 3: Further, you should report add-on code +64495 (…third and any additional level[s] [List separately in addition to code for primary procedure]). 

Note: You should report only one unit of service for the last two facet joint levels (L3-L4 and L4-L5). It is important to note that the code descriptor for the 64495 add-on code specifies “third and any additional level[s].” 

Tip: For paravertebral facet joint injections, you can bill add-on codes if your physician’s documentation supports the services.