Anesthesia Coding Alert

Enhance your coding with expanded answers to 2 reader questions  Subscribers raised questions about two reader questions/answers in the September Anesthesia & Pain Management Coding Alert. Our expanded answers will clarify the points made and make sure you code these types of injections correctly the first time. 64470 Applies to Medial Branch Facet Block Question: Our physician administered a facet block via the patient’s medial branch nerves, above and below the C4-C5 facet. He used fluoroscopic guidance. How should I code this? Answer: You should base coding for paravertebral facet joint and paravertebral facet joint nerve injections on the facet joint level instead of the number of individual nerves injected.

Example: For the C4-C5 facet joint, the provider can insert the needle into the facet joint itself (which would be one injection) or can perform two injections (one at each of the two nerves -- C4 and C5 paravertebral facet joint nerves [or medial branches] -- that innervate that joint). Either way, you report 64470 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level) only once. In this instance, base the number of “levels” on the number of facet joint levels your physician injects, not the number of needle insertions.

According to CPT parenthetical notes, you should report fluoroscopy separately when your provider uses fluoroscopy for radiologic guidance and documents it. Some carriers even state that a provider must use radiologic guidance to ensure the needle placement for facet joint injections. 

Code change alert: In the past, you would submit 76005 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint], including neurolytic agent destruction) for the fluoroscopic guidance during this procedure. But CPT 2007 deleted 76005, which means you should submit new code 77003 instead. The descriptor is the same one you’re used to for 76005; CPT 2007 just created a new section of codes for fluoroscopic guidance. 

Modifier reminder: Depending on the type of physical setting where your physician performs the injection, you might need to append modifier 26 (Professional component) to indicate that your provider only performed the professional component of 76005. Remember 51 or 59 for Multilevel Injection Question: Our physician administered a three-level lumbar injection for pain management. Which modifiers should I append for correct submission? Answer: Knowing which CPT codes apply to the injection location determines whether you should append either modifier 51 (Multiple procedures) or 59 (Distinct procedural service). Because of this, you must know what anatomic structure your physician [...]