Orthopedic Coding Alert

In our November issue, we advised that coders should report one unit of 64470 and one unit of 64472 when the surgeon administers a facet block via the patient's medial branch nerves, above and below the C4-C5 facet.

However, if the surgeon only treated one facet joint nerve, you should report one unit of 64470 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level).

Even though the surgeon injected the upper and lower portions of the facet joint nerve, you should not add +64472 (- cervical or thoracic, each additional level [list separately in addition to code for primary procedure]) to your claim. The September 2004 CPT Assistant states, -The paravertebral facet joint injection codes 64470-64476 should be reported per spinal level.-

Therefore, unless your surgeon injected both sides of the nerve (bilateral injections), you should report just one unit of 64470.

Some carriers consider fluoroscopic guidance part of the procedure, but others allow you to separately report the fluoroscopy (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).