Pain Management Coding Alert

Question: Our physician documented that he administered injections to the patient’s L1, L2, L3, L4, and L5 paravertebral facet joint nerves. Can I bill both add-on codes +64494 and +64495 with 64493? 

Nebraska Subscriber

Answer: Yes, you can bill all of these codes together if the documentation supports the services. 

These lumbar facet joint nerves provide sensory innervation to the L2-L3, L3-L4, L4-L5 and L5-S1 facet joints. The primary code is 64493 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral; single level) reported for the L2-L3 facet joint. Then add +64494 (…second level [List separately in addition to code for primary procedure]) for the second L3-L4 level injection and +64495 (…third and any additional level[s] [List separately in addition to code for primary procedure]) with only one unit of service for the last two facet joint levels (L4-L5 and L5-S1). It is important to note that the code descriptor for the 64495 add-on code specifies “third and any additional level[s].”