Radiology Coding Alert

Question: If the physician shoots a single-view lumbar x-ray for diagnosis on the same day she administers the patient's paravertebral facet injection, can we code both services?

Oregon Subscriber

Answer: Yes, you should be able to report both services because the Correct Coding Initiative (CCI) does not bundle the procedures together. But certain conditions apply.

Assuming your provider administered injections to the lumbar area, code the appropriate number of injections using the following codes:

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

+64494 -- ... second level (List separately in addition to code for primary procedure)

+64495 -- ... third and any additional level(s) (List separately in addition to code for primary procedure).

For the single-view lumbar x-ray, you should report 72020 (Radiologic examination, spine, single view, specify level).

Caution: Codes 64493-+64495 include fluoroscopic and CT guidance, so you should not "carve out" the permanent image portion of the needle guidance and code it separately. To report 72020, you must be able to prove separate and distinct medical necessity for the diagnostic study.