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Eli's Rehab Report

Reader Questions:

Nerve Injections May Mean 64520

Published on Wed Apr 06, 2005

Question: How do I code for paravertebral nerve block, L3-4, L4-5, L5-S1? The physiatrist injected the nerve, not the space. This was not a facet.


Maine Subscriber


Answer: In the past, you might have reported 64440 (Paravertebral nerve [thoracic, lumbar, sacral, coccygeal], single vertebral level) and 64441 (Paravertebral nerves, multiple levels [eg regional block]), but CPT deleted these codes in the year 2000. The key to finding correct (and current) codes for this service is to go back to your provider and ask what anatomic structure did they perform the injection on.
 
The term paravertebral merely means "along side" the vertebrae, which could mean many different anatomic structures that have different CPT codes, such as:
  

  • paravertebral facet joint nerve (a.k.a. medial branch nerves) (64475, Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, single level or 64476, ... lumbar or sacral, single level);
      
  • selective spinal nerve root (64483, Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level or +64484, ... lumbar or sacral, each additional level [List separately in addition to code for primary procedure);
      
  • dorsal root ganglion (64999, Unlisted procedure, nervous system);
      
  • sympathetic nerve chain (64520, Injection, anesthetic agent; lumbar or thoracic [paravertebral sympathetic]), etc.

    Until you know what the provider blocked, you can't compliantly code the procedure.

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