Neurosurgery Coding Alert

Report only destruction with same session/location block When coding for facet joint injections, you must read the documentation carefully to determine whether the physician performed a nerve block (64470-+64476) or more extensive nerve destruction (64622-+64627). Additionally, you must know how CPT's definition of "level" varies between the two types of procedures. Count -Joints- for Nerve Blocks When reporting nerve blocks, you should focus on the "joint" -- the area between adjacent nerves -- that the physician targets, instructs Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting, in Denver. Therefore, one nerve block "level" will actually involve two nerves. Example 1: If the physician provides diagnostic nerve blocks for C2, C3 and C4, he is addressing three nerves but only two levels (the joint at C2/C3 and the joint at C3/C4), notes pain management specialist Richard Kennedy, MD. Example 2: If the physician wishes to block the nerves from L1-L4, he is addressing four nerves (L1, L2, L3 and L4) but only three levels (L1/L2, L2/L3 and L3/L4). Under CPT rules, you may report one unit of 64470 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level) for the initial level the physician addresses in either the cervical or thoracic region. For each additional cervical or thoracic level that the physician targets beyond the first, you may apply +64472 (-cervical or thoracic, each additional level [list separately in addition to code for primary procedure]). In the first example above, for instance, you would report 64470 for the initial injection (at C2/C3) and one unit of +64472 for the additional injection (at C3/C4). Similarly, apply 64475 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, single level) for the first lumbar or sacral level, and +64476 (-lumbar or sacral, each additional level [list separately in addition to code for primary procedure]) for each additional lumbar or sacral level. In our second example above, therefore, you would report 64475 for the initial lumbar level (L1/L2) and +64476 x 2 for the two additional levels (L2/L3 and L3/L4). Multiple Injections Won't Mean Multiple Code Units Note that "per level" does not mean per injection. This is an important distinction because the physician may provide more than one injection per level. For example, the surgeon may provide a left-side C4/C5 intra-articular injection via a single needle puncture, or he may administer two separate injections to the medial branch nerves supplying the C4/C5 facet joint. In either case, you would report a single unit of 64470, Hammer says. Additionally, the L5/S1 facet joint level receives innervation from three nerves (the L4, L5 and S1 para-vertebral facet joint [...]