Pain Management Coding Alert

Question: The pain management specialist administered three transforaminal epidural injections at the S1, S2, and S3 nerve branches. He confirmed needle tip placement with fluoroscopic views. How do I code this?

Indiana Subscriber 

Answer: There are four levels involved with this procedure. Code so that the payer clearly understands that your provider injected separate and distinct nerves:

• 64483 (Injection[s], anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance [fluoroscopy or CT]; lumbar or sacral, single level) for the L5 foramen 
• +64484 (…each additional level [List separately in addition to code for primary procedure]) for the S1 injection
• +64484-59 (Distinct procedural service) for the S2 injection 
• +64484-59 for the S3 injection.