Eunice Posted Thu 26th of January, 2012 17:23:26 PM
Our radiologist start doing pain management injection and not sure how to code this..
64479 for left L4-L5 facet joint
62311 for epidural
what is correct procedure for "L4-L5 and L5-S1 interspinous"?
Thank you for all your help!
PROCEDURE: The patient was identified and consented for epidural, interspinous and facet steroid injections. The specific risks discussed included nausea, reaction to medications, bleeding, infection, cumulative effects of steroids and injury to other org
ans. The patient understood the risks and expectations of the procedure.
The patient was placed prone on the table. After infiltration of the tissue with 1 percent lidocaine, 22-gauge needles were placed using fluoroscopic guidance into the L4-L5 and L5-S1 interspinous intervals, left L4-L5 facet joint, and the epidural space
at the L3-L4 level. The positions of the needles were confirmed using 4 cc of Isovue-200M. Subsequently, a divided dose of 120 mg of Kenalog and 7 cc of 0.5 percent Marcaine were injected.
The patient tolerated the procedure well. At the end of one hour observation, the patient reported that his discomfort decreased to 5 out of 10 with walking.
He was given discharge instructions and asked to keep a log of his pain level for the next 24 hours.
IMPRESSION: FLUOROSCOPIC GUIDED L4-L5 AND L5-S1 INTERSPINOUS, LEFT L4-L5 FACET, AND EPIDURAL STEROID INJECTIONS.
SuperCoder Answered Fri 27th of January, 2012 10:29:21 AM
The Facet codes are as follows:
64493 — Lumbar or Sacral; single level.
64494 —Second level Injection, Lumbar or Sacral; single level.
Transforaminal Epidural Injections:
64483 - Injection, anesthetic agent and/or steroid, Transforaminal Epidural; Lumbar or Sacral, single level
64484 – Lumbar or Sacral, each additional level
62311: INJECTION, SINGLE (NOT VIA INDWELLING CATHETER), NOT INCLUDING NEUROLYTIC SUBSTANCES, WITH OR WITHOUT CONTRAST (FOR EITHER LOCALIZATION OR EPIDUROGRAPHY), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (INCLUDING ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), EPIDURAL OR SUBARACHNOID; LUMBAR, SACRAL (CAUDAL)
Eunice Posted Fri 27th of January, 2012 17:22:45 PM
Can I bill 77003 (flurorscopic guidance) with 62311 additional to 64493, 64494, 64483 and 64484.
SuperCoder Answered Fri 27th of January, 2012 18:23:51 PM
•The SI Joint Injection code (27096) has been amended. The 2012 CPT manual includes a revised SIJ (27096) code that states that fluoroscopy is bundled into code 27096. Specifically, the new descriptor now states “with image guidance”. There is also a new parenthetical under CPT code 77003 (Fluoroscopy) that now states “Do not report 77003 with 27096”. Additionally, the 2012 CPT manual states that “if CT or fluoroscopic imaging is not performed, use 20552”. CPT code 20552 is the code for single of multiple injection trigger point injections. Arthrography (code 73542) is also included in the coder descriptor for this procedure – which means it too is bundled into the procedure.
•There is a new Facet parenthetical preceding the facet codes (64490 – 64495) which states that “Image guidance [fluoroscopy or CT] and any injection of contrast are inclusive (bundled) components of 64490 – 64495. Imaging guidance and localization are required for the performance of paravertebral facet joint injections described by code 64490 – 64495. If imaging is not used, report 20552 – 20553. If ultrasound guidance is used, report 0213T – 0218T.”