Orthopedic Coding Alert
2020 Injection Codes
Question: After a level-four evaluation and management (E/M) service for a new patient, the physician diagnoses right-sided sciatica. My physician injected an anesthetic agent into the nerves innervating the patient’s sacroiliac joint. He injected five nerves and used computed tomography (CT) guidance to perform this procedure. Which CPT®/ICD-10 codes should I report? Texas Subscriber Answer: You should be reporting the new-to-2020 code 64451 (Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)) for this procedure. Also, append M54.31 (Sciatica, right side) to 64451 to represent the patient’s sciatica. For the E/M service, report 99204 with modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) appended to show that the E/M was separate and significantly identifiable from the injection services. (Remember to append M45.31 to 99204 as well.) Don’t miss: With 64451, you should report one unit for any number of nerves innervating the sacroiliac joint inject, regardless of the number of injections. Also, since imaging guidance is an inclusive component of 64451, you cannot report the CT guidance separately. This is a different procedure from injecting the sacroiliac joint itself, which is reported with code 27096 (Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed), which requires image guidance and includes arthrogram, when performed. Caution: The 64451 code is new for 2020. In previous years, you’d have reported 64450 (Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch) to report this injection. You should be all set to file with 64451, but if you haven’t used it yet, consider contacting the payer to ensure that they are accepting 64451 for this service. (All payers should be accepting this code by now, but strange things happen sometimes.)
Orthopedic Coding Alert
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