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TON with an intra-articular facet injection

Mike Posted Wed 02nd of July, 2014 13:09:01 PM

What is proper billing for a Right third occipital nerve block WITH a C2-C3 intra-articular facet injection?

64490, and 64490 modifier 22 ?

SuperCoder Answered Fri 04th of July, 2014 07:02:50 AM

64490 represents "Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level".

This code is billed "per level". C2-C3 is a single level.

You should bill 64490 with RT modifier. Modifier 22 - 'Increased Procedural Service' is not applicable in this scenario.

Thanks !!

Mike Posted Tue 08th of July, 2014 15:50:08 PM

I understand 64490 "injection(s)" terminology, so do we need to use a different CPT code the TON injection? Doesn't seem correct not to bill for both injections??

SuperCoder Answered Wed 09th of July, 2014 06:24:50 AM

The third occipital nerve (TON) is the superficial medial branch of the C3 spinal nerve's dorsal ramus. It innervates some of the neck muscles and the C2-3 facet joint. Pain stemming from this joint can be referred to the occiput and even as far as the frontal region and orbit.

The provider do not inject TON in separation with C2-C3 facet joint. The aim of C2-C3 facet joint injection is ultimately to block third occipital nerve fibres innervation to the facet joint. If your provider clearly documents that he has injected the TON separately from C2-C3 facet joint, then you may use second code.

Thanks !!

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