Anesthesia Coding Alert

Question: My physician performs a two-level facet injection of the L4 and L5 spine on a patient and adds modifier -51 to 64476. Is this correct?

New York Subscriber

Answer: No. Modifier -51 (multiple procedures) should not be appended to add-on procedure codes because the fees for these additional services are reduced already and attaching modifier -51 may result in even lower payment.

Facet joint injection is an injection of a long-lasting steroid, such as cortisone, in the facet joints in the back. The steroid reduces the inflammation and/or swelling of tissue in the joint space. Injections may be placed in the cervical/thoracic or the lumbar sacral area. Of the four codes CPT used to describe this service, two are add-on codes to be used when more than one injection is required.

The following codes should be used to report facet joint injections:

64470 injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level;

64472 cervical or thoracic, each additional level (list separately in addition to code for primary procedure);

64475 lumbar or sacral, single level; and

64476 lumbar or sacral, each additional level; (list separately in addition to code for primary procedure).

Note: CPT lists In addition to or add-on codes with a + on the left margin.

Add-on codes such as 64772 and 64476 cannot be reported without the primary code (64470 for 64472 and 64475 for 64476) also being billed.

Even when the multiple procedure guidelines apply, your carrier may want modifier -51 appended because many Medicare carriers automatically discount multiple procedures and/or apply modifier -51 themselves. Ask your carrier if modifier -51 is still required.

Answers for Reader Questions provided by Patricia Bukauskas, CMM, CPC, an independent pain management coding and reimbursement specialist in Aliquippa, Pa.