Revenue Cycle Insider

Question: How should I report bilateral paravertebral facet joint injections performed during the same session at the contiguous thoraco-lumbar and lumbar levels (T12-L1 and L1-2) with fluoroscopy guidance for a Medicare beneficiary?

Illinois Subscriber

Answer: This is a little tricky to code because CPT^® defines spine regions in such a way that these joints are classified differently. However, Medicare Administrative Contractor (MAC) National Government Services (NGS) provides a local coverage determination (LCD) >Billing and Coding article that gives a junction-level billing instruction for such a scenario: “Billing contiguous facet interventions in the thoraco-lumbar T12-L1 and lumbar segments (L1-2) during one session will be allowed and considered to be one spine (lumbar) region.”

According to this article, you’ll report these injections with 64490 (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) appended with modifier 50 (Bilateral procedure), as well as +64494 (Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure)) also appended with modifier 50.

The article says: “For bilateral paravertebral facet injection of the T12-L1 and L1-L2 levels or nerves innervating that joint, use 64490 with modifier 50 and 64494 with modifier 50. One to two levels, either unilateral or bilateral, are allowed per session per spine region (i.e., two (2) unilateral or to two (2) bilateral levels per session).”

Note: NGS has recently rebranded and, as of April 1, is now called Wellpoint Federal. However, according to its website, its name is the only thing that has changed.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC