Neurosurgery Coding Alert

Question: Our neurosurgeon administered a facet block via the patient's medial branch nerves, under fluoroscopic guidance, with injections both above and below the C3-C4 facet. What is the appropriate coding? Oklahoma Subscriber Answer: Because the surgeon treated a single facet joint nerve (that is, one "level"), you should report a single unit of 64470 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level). You should report only one unit of 64470 even though the surgeon injected the upper and lower portions of the facet joint nerve. The AMA dictates this coding with instructions in the September 2004 CPT Assistant, which states, "The paravertebral facet joint injection codes 64470-64476 should be reported per spinal level." Bottom line: The number of spinal levels the surgeon treats, not the precise number of injections, matters most for coding. Keep in mind that 64470 is a unilateral code. Therefore, if the surgeon injected targeted nerves on both sides of the facet joint, you could report 64470 appended with modifier 50 (Bilateral procedure). If the surgeon performs the fluoroscopic guidance personally, you may report 77003 (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) in addition to 64470. In spite of some payers- efforts to bundle fluoroscopic guidance to spinal injections, CPT instructions are clear that you may report fluoroscopic guidance, when performed, separately from spinal injection procedures. Medicare and other payers that follow national Correct Coding Initiative edits specifically allow 77003 with 64470-64484, among other injection procedures.