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64493 and 64450, 64635 and 64640

Kerry Posted Mon 29th of July, 2019 09:53:15 AM
What are the correct codes to use when performing an MBB of L5-S1 as well as a lateral branch block of S1, S2, S3? Currently I am using 64493 (MBB L5-S1) and 64450 x3 (S1, S2, S3) but my doctor is under the impression since he is already blocking S1 in the MBB that we cannot bill it twice, so he thinks the lateral branch blocks should be billed out as 64450 x2. Also, same thing when it comes to the RFA. What are the correct codes to use when performing an RFA of L5-S1 as well as RFA to the lateral branch of S1, S2, S3? Currently I am using 64635 (RFA L5-S1) and 64640 x3 (RFA 1, S2, S3) would like to know if this is correct or if this should be 64640 x2 as well.
SuperCoder Answered Tue 30th of July, 2019 05:44:17 AM

Hi Kerry,

The lateral branch nerve is a peripheral nerve and would be reported with CPT code 64450, Injection, anesthetic agent; other peripheral nerve or branch, when a lateral branch nerve block is performed.

Please note: CPT code 64450 should only be reported per nerve or branch and not per injection.

Therefore, for the 3 lateral branch block injections at S1, S2, S3, report 3 units of CPT code 64450, Injection, anesthetic agent; other peripheral nerve or branch.

Also, bill 64493 for MBB L5-S1. Here, L5-S1 is considered as one joint.

NOTE: According to the AMA, the code series for medial branch blocks and the facet joint injections are the same (i.e., CPT series 64490-64495), with reporting based on the number of facet joints injected, not the number of nerves injected. For example: If two medial branch nerves are injected only one (1) facet joint injection codes would be reported despite the fact 2 nerves were injected, since each facet joint is connected to two medial nerves.

CPT 64640 is an appropriate code to report for each individual peripheral neurolytic nerve destruction procedure performed ( radiofrequency techniques) at the L5, S1, S2, and S3 nerves.


NOTE: When performing individually separate nerve destruction, each peripheral nerve root
neurolytic block is reported as destruction of a peripheral nerve, using code 64640, Destruction by
neurolytic agent; other peripheral nerve or branch. In this instance, for peripheral nerve root
neurolytic blocks (destruction) of L5, S1, S2, and S3, code 64640 should be reported four times. Thecoder should append modifier 59, (Distinct Procedural Service), to the second and subsequent listings of code 64640 to separately identify these procedures.

Kerry Posted Tue 30th of July, 2019 10:04:17 AM
Ok, we have decided to rephrase this since our provider is telling us something different. We want to make sure that we are on the same as him. My doctor is performing a L5-S1 MBB of the facet joint, as well as lateral branch block of S1, S2, and S3. How is this to be billed?  I am currently billing 64493 + 64450 x3.  My doctor is under the impression since he is already blocking (L5) -S1 in the MBB of the facet joint that he cannot bill for S1 again in the lateral branch block – making this 64493 + 64450 x2.  What quantity of 64450 is correct? My doctor is performing a L5-S1 RFA of the facet joint, as well as RFA of the lateral branches of S1, S2, S3. How is this to be billed?  I am currently billing 64635 + 64640 x3.  My doctor is under the impression since he is already performing the RFA on (L5) -S1 in the facet joint that he cannot bill for S1 again in the lateral branch RFA – making this 64635 + 64640 x2.  What quantity of 64640 is correct?
SuperCoder Answered Wed 31st of July, 2019 03:14:59 AM

Hi Kerry,

It is appropriate to bill 64493 + 64450 x3 for a L5-S1 MBB of the facet joint, as well as lateral branch block of S1, S2, and S3.

64635 + 64640 x3 for L5-S1 RFA of the facet joint, as well as RFA of the lateral branches of S1, S2, S3.

NOTE: The nerve that passes through L5-S1 is called L5 nerve root.

64493 will cover individual nerve passing between L5-S1, that is L5 nerve root.

64635 will cover individual nerve that is L5 nerve root that passes between L5-S1, as this code is for facet joint nerve.

Hope it helps.

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