Neurology & Pain Management Coding Alert

Question: When billing for multilevel lumbar facet joint nerve radiofrequency, (i.e., L2, L3, L4 and L5), we report 64622 for the first level and +64623 for each additional level up to a total of four. Our payers deny the fourth level as a duplicate, even when we append a modifier. How should we differentiate between the third and fourth levels so they'll both be reimbursed?New Jersey SubscriberAnswer: You're correct in reporting 64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level) for the first level and +64623 (...lumbar or sacral, each additional level [List separately in addition to code for primary procedure]) for additional levels.Option: If all the levels were on the same side, rather than submit as four single line items, you could instead bill the add-on codes as a single line item and 3 in the "units of service" field, 24G of the 1500 [...]