Neurosurgery Coding Alert

Question: What codes should I use for lumbar paravertebral facet nerve injection and a lumbar nerve root injection? Also, my office uses "LNR" as an interoffice abbreviation, and I-m not sure if it stands for "lumbar nerve root" or "lumbar paravertebral facet nerve injection." Is that the same code or two different ones?

Kansas Subscriber

Answer: First of all, for lumbar paravertebral facet joint nerve injections, you-ll want to look to codes 64475 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, single level) and 64476 (- lumbar or sacral, each additional level [list separately in addition to code for primary procedure]).

What it is: A facet joint injection is an injection of a long acting local anesthetic agent and/or steroid into the paravertebral facet joint, medial branch nerve or facet joint nerve under fluoroscopic guidance. These can be either diagnostic or therapeutic. Want to know more? You can find complete information for applying these codes in Neurosurgery Coding Alert, Vol. 9, No. 8, pages 57-59.

For lumbar nerve root injections, look to 64483 (Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level) and 64484 (- lumbar or sacral, each additional level [list separately in addition to code for primary procedure]).

What they are: Nerve root blocks are injections of local anesthetic, with or without the addition of steroid (cortisone) around the spinal nerves at the point at which they leave the spine (their roots). It is given to diagnose and to treat pain which tends to travel down the leg.

As to the "LNR" mystery, the paravertebral facet joint injection and the nerve root injection are not interchangeable, and you would use different codes for each. Your best bet is to ask your provider to clarify what he means by this abbreviation and point out its possible double-meaning.

Watch out: You must also be careful not to confuse either of these injection types with nerve destruction (64622-64627) or trigger point injections (20552-20553).