Wiki CPT 64483 and 64493

[gayathria]

Hi guys help me with this query

Can i bill cpt-64483 and 64493 at same level eg: L3-L4

Thanks in advance !

 

[thomas7331]

I've never encountered this, but there are no conflicts between the codes so I don't see why you wouldn't be able to code both if both procedures are documented. The codes are for two different injection sites (epidural vs. facet joint), even if at the same level.

 

[jkyles]

Hi there, you won't encounter an NCCI edit for the two services but every policy I've seen states that multiple blocks on the same day are generally not necessary. For example the MACs recently adopted a uniform policy for facet joint interventions that includes the following:

It is not routinely necessary for multiple blocks (e.g., epidural injections, sympathetic blocks, trigger point injections, etc.) to be provided to a patient on the same day as facet joint procedures. Multiple blocks on the same day could lead to improper or lack of diagnosis. If performed, the medical necessity of each injection (at the same or a different level) must be clearly documented in the medical record. For example, the performance of both paravertebral facet joint procedures(s) and a transforaminal epidural injection (TFESI) at the same or close spinal level at the same encounter would not be expected unless a synovial cyst is compressing the nerve root. In this situation, TFESI may provide relief for the radicular pain, while the facet cyst rupture allows nerve root decompression. Frequent reporting of multiple blocks on the same day may trigger a focused medical review.

Make sure the documentation will stand up to review and be aware that if you do it a lot, you can expect an audit.