Wiki Dorsal rami/paravertebral blocks

[mgrimaldi]

I need help with coding this procedure.

Today we repeated dorsal rami/paravertebral blocks at C7 and T1 bilaterally. Patient was placed in the sitting position and sedated. The spinous processes were palpated and 25-gauge spinal needles were inserted 1 fingerbreadth lateral on each side of the spinous process. Each was advanced until bone was contacted and paresthesia was elicited.

No fluoroscopy was used. Thoughts??

Thanks

 

[dwaldman]

First check with the local coverage determination policy for the Medicare carrier you are billing or the policy of the private payer to make sure they cover dorsal rami/facet injection without fluoroscopy if they do not you would have to report 20552 with the GZ modifier.


Image guidance [fluoroscopy or CT] and any injection of contrast are inclusive components of 64490-64495. Imaging guidance and localization are required for the performance of paravertebral facet joint injections described by codes 64490-64495. If imaging is not used, report 20552-20553. If ultrasound guidance is used, report 0213T-0218T)

(For bilateral paravertebral facet injection procedures, use modifier 50)

(For paravertebral facet injection of the T12-L1 joint, or nerves innervating that joint, use 64490)