Wiki Right Sacroiliac Joint Steroid Injection via L5 dorsal ramus block, S1 lateral branch

[heather@interventionalpain.com]

Right Sacroiliac Joint Steroid Injection via L5 dorsal ramus block, S1 lateral branch block, S2 lateral branch block, and S3 lateral branch block under Fluoroscopy
Can someone ensure me that I am coding this correctly, please?
64493, RT 724.2, 724.6
64450, RT 724.2, 724.6
64450, RT, 59 724.2, 724.6
64450, RT, 59 724.2, 724.6

Also, when reading the Medicare LCD, I am only seeing ICD9 code 354.0 as being medically necessary.
Any insight would be greatly appreciated.
Thanks!

 

[dwaldman]

ICD-9 354.0 is for carpal tunnel syndrome. You might want to confirm you are reviewing the LCD for sacroiliac joint injections or paravertebral facet joint injections.

I believe the L5 injection would fall under CPT 64450 also. This is does not appear to be for treatment of the L5-S1 Facet joint, so CPT 64493 would be inappropriate if this procedure is for innervation contributing to the SI joint then this would be similar the S1-S3 lateral branch procedures that are being performed.

Would have confirm that modifier 59 is accepted with the same code on multiple lines. They might only accept this modifier for codes that have a NCCI coding edit for certain Medicare carriers.

The alternative would be:

64450 RT
64450 RT (x3) with additional note electronic and on claim form:
Three additional levels performed on RT side

 

[dwaldman]

On the second line I forgot in the previous post, the 51 modifier if they will not take the 59

64450 RT
64450 51 RT (x3) Three additional levels performed on RT side