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K Posted Thu 01st of February, 2018 13:30:29 PM
Our orthopedic doctor wants to bill a 64483 and 0232T and in the same session bill a 644993 and 0232T. My thought is that the 64483 and 64493 would be included in the 0232T. How would you code this and can 0232T be billed twice? The overlying skin was anesthetized at each level. 25 gauge spinal needles were used under fluoroscopic imaging in AP, oblique and lateral views to enter the superior aspect of each of the neural foramina, After negative aspiration, 0.5mls of omnipaque contrast was injected at each level revealing epidurogram spread without any vascular uptake. A butterfly needle was used to draw 30cc of patients own blood from his arm under sterile conditions into PRP syringe. The blood sample was placed in a centrifuge for 3 minutes to spin out the patients plasma. 2cc of the 3cc of PRP was injected into the foraminal space. A 25 gauge spinal needle was the advanced to the corresponding facet.....and then the procedure is repeated for the facet. Thank you.
SuperCoder Answered Fri 02nd of February, 2018 04:32:14 AM

In CPT 64483, the procedure is for injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural (e.g. triamcinolone and methylprednisolone), whereas in the CPT 64493 the provider injects a diagnostic or therapeutic agent into a facet joint or he may perform the injection for nerves innervating that joint. The goal of this procedure is to treat spinal pain or to identify the exact source of pain. However, in CPT 0232T provider prepares PRP by centrifuging blood collected from the patient and injects it into the site of injury under imaging guidance. The provider performs this procedure to treat injuries and to stimulate faster bone repair or healing after various surgeries. If the PRP injection was for therapeutic purposes, then it will not to be coded with CPT 64493 as it will be bundled. But, while billing CPT 64483 it can be billed since it is not an anesthetic agent and/or steroid.

As per CCI edits guidelines, there is no such bundling between all three codes. Again, the procedure location and session is the same, payer may raise the question for the applied therapeutic agent. It is recommended to bill with proper op-report documentation.

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