Radiology Coding Alert

Revised directions change ultrasound, T12-L1 reporting.

While you're getting up to speed on CPT 2011 changes, remember to check for updated or revised guidelines, not just code descriptors. This year's updates bring new details for coding some common injection procedures, as pointed out at the AMA's CPT and RBRVS 2011 Annual Symposium in Chicago. Read on for a few pointers to help you stay on the right track.

Check Revised Paravertebral Injection Notes

The introduction of new codes for paravertebral facet joint injections in 2010 (64490-+64495) meant changes to how you reported related codes. During the CPT and RBRVS Symposium, Douglas G. Merrill, MD, MBA, of the American Society of Anesthesiologists, pointed out two revised guidelines dealing with paravertebral facet (spinal) joint procedures.

Ultrasound clarification: Instructions in CPT 2010 directed you to report 64999 (Unlisted procedure, nervous system) if the provider used ultrasound guidance during paravertebral facet joint injections. The AMA released a correction later in 2010, and the CPT 2011 manual clarifies the situation. If your provider used ultrasound guidance when administering paravertebral facet joint injections, you should report the appropriate code(s) from 0213T-0218T (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with ultrasound guidance ...). You should not use 64999 for that service.

T12-L1 change: CPT 2010 guidelines mandated that you report 64493 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [for nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral; single level) for an injection to the T12-L1 joint, or nerves innervating that joint.

New 2011 guidelines direct you to submit 64490 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [for nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic; single level) instead.

In addition, the 2011 guidelines direct providers to report paravertebral facet joint injections performed without image guidance (not a common task for a radiologist) using the appropriate trigger point injection code. Submit either 20552 or 20553 (Injection[s]; single or multiple trigger point[s]...) rather than choosing from the 20550-20553 code range (to which 2010 guidelines directed you).

Reminder: Code paravertebral facet joint blocks (64490- 64495) bilaterally if the physician injects two sides at the same level. "These are unilateral blocks," Merrill explained. Use modifier 50 (Bilateral procedure) for bilateral paravertebral facet injection procedures.

Take Care When Reporting Somatic Nerve Injections

In addition to presenting 2011 changes, Merrill noted three somatic nerve injections identified through CMS's "Fastest Growing" screen:

• 64415 -- Injection, anesthetic agent; brachial plexus, single
• 64445 -- ... sciatic nerve, single
• 64447 -- ... femoral nerve, single.

"Increased utilization can be indications of incorrect coding," explains Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACSPM, CHCO, owner of MJH Consulting in Denver, Colo.

"These may become target areas for the OIG Workplan, such as facet joint injections and transforaminal epidural injections have been in recent years."