Jenc2015
New
Need help please, how would you code this:
Technique:
The patient ambulated to the procedure suite, was positioned on the fluoroscopy table and made comfortable there. All providers in the room wore masks. The operator cleansed his hands and donned sterile gloves. The patient's neck was prepped and draped in normal sterile fashion. Using AP and lateral fluoroscopy, the anatomic landmarks were identified, taking time to meticulously line up the articular pillars on the lateral view of the above delineated joints. 1% lidocaine was injected intradermally to anesthetize the skin over those articular pillars. 25g 2 inch spinal needles were then driven through the skin to the center of the articular pillar of C3, C4, and C5 and the joint line of C2-3 for TON on the Left side. Flouroscopic guidance was used to direct the needles into a safe and diagnostically beneficial position.. Needle position was checked in AP view and was satisfactory. After negative aspiration 0.5ml of the above mentioned injectate was then administered at each level. The needles were then withdrawn. Chlorhexidine was then removed from the skin and a sterile bandage was applied over the needle puncture site. The patient tolerated the procedure well and there was no apparent complication.
I have seen online that when documented as C3, C4, and C5 it would be done as nerves minus one = 2 levels billed. Then throw in the TON; I have seen where it is considered part of the C2-C3 joint and not coded separately, and I have seen that it is coded separately using the 64450 CPT. My provider dropped codes 64490, 64491, 64492 and 64450.
Technique:
The patient ambulated to the procedure suite, was positioned on the fluoroscopy table and made comfortable there. All providers in the room wore masks. The operator cleansed his hands and donned sterile gloves. The patient's neck was prepped and draped in normal sterile fashion. Using AP and lateral fluoroscopy, the anatomic landmarks were identified, taking time to meticulously line up the articular pillars on the lateral view of the above delineated joints. 1% lidocaine was injected intradermally to anesthetize the skin over those articular pillars. 25g 2 inch spinal needles were then driven through the skin to the center of the articular pillar of C3, C4, and C5 and the joint line of C2-3 for TON on the Left side. Flouroscopic guidance was used to direct the needles into a safe and diagnostically beneficial position.. Needle position was checked in AP view and was satisfactory. After negative aspiration 0.5ml of the above mentioned injectate was then administered at each level. The needles were then withdrawn. Chlorhexidine was then removed from the skin and a sterile bandage was applied over the needle puncture site. The patient tolerated the procedure well and there was no apparent complication.
I have seen online that when documented as C3, C4, and C5 it would be done as nerves minus one = 2 levels billed. Then throw in the TON; I have seen where it is considered part of the C2-C3 joint and not coded separately, and I have seen that it is coded separately using the 64450 CPT. My provider dropped codes 64490, 64491, 64492 and 64450.