Neurosurgery Coding Alert

Question: Our surgeon performed an intra-articular joint injection in the cervical region. Should I use 64470 or 64472?

New Jersey Subscriber

Answer: Your surgeon likely injected the paravertebral facet joint intra-articularly. If he injected more than one level, you should bill 64470 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level) and +64472 (... cervical or thoracic, each additional level [list separately in addition to code for primary procedure]). If he injected one cervical level only, you should report 64470 without the add-on code.

Because CPT defines 64470 and 64472 as unilateral procedures, you should append modifier -50 (Bilateral procedure) for any injections that the surgeon performs at both the left and right paravertebral facet joints. Keep in mind that 64472 is an add-on code, and you must bill it with 64470.

You should report 64470 only for the first vertebral level that the physician injects. You should bill 64472 for any additional levels that the physician injects. The surgeon should clearly document the specific levels that he injects (such as C2-C3, C3-C4, etc.).

Physicians usually perform these procedures under fluoroscopic guidance, so you can report them with a radiology service (such as 76005, Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, para-vertebral facet joint, paravertebral facet joint nerve or sacroiliac joint], including neurolytic agent destruction). Don't use these injection codes for local anesthesia that physicians use with surgical procedures.

Do not assume that the physician injected more than one level. Check with your surgeon and recommend that he more clearly document these services in the future - not only for billing and coding, but also for legal reasons.