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Lumbar Transforaminal

Lindye Posted Thu 27th of June, 2013 13:43:48 PM

ONE more question on procedure note please-
Level L1 L2 bilateral lumbar transforaminal esi
A 25 gauge chiba needle was advanced to the foramen at the involved level under flouroscopic guidance. Contrast was used to outline the foraminal space. Marcaine 0.25% 0.5cc with Depo Medrol 40mg was injected at the involved levels.No complications noted.
Will you code this for me please? I don't understand how you tell the difference between coding for a single level vs 2 level. Thanks for your help.

SuperCoder Answered Thu 27th of June, 2013 21:36:31 PM

This is 64483-50.

Verify the type of imaging guidance your provider used for the injection. Code 64483 includes fluoroscopic or CT guidance. If your physician used ultrasound guidance, you should report 0230T (Injection[s], anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level) instead of 64483.

In your case it is flourscopic guidance, hence no additional code.

The transforaminal epidural injection codes 64479-64484 describe injections that enter the epidural space through the intervetebral foramen. This technique differs from interlaminar [translaminar] epidural injection technique (62310-62311) and the paravertebral facet joint nerve injection technique (64490-64495). Since the vertebral artery (in the cervical spine), radiculomedullary arteries, as well as the spinal cord are in close proximity to the nerve root, this procedure involves a much higher risk with more work than a translaminar epidural injection.
Transforaminal epidural injection codes 64479, 64480, 64483, and 64484 now include the fluoroscopic and computed tomographic (CT) needle placement imaging services in the code descriptors. Imaging guidance (fluoroscopy or CT) and any injection of contrast are inclusive components of codes 64479-64484.

Coding Tip
Codes 64479-64484 are inherently unilateral procedures. When these procedures are performed bilaterally, they should be appended with modifier 50 or with a HCPCS Level II modifier “RT” or “LT” depending upon payer requirements.

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