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Neurology & Pain Management Coding Alert

Reader questions:

Submit 20605 or 22899 Bertolotti Joint Injections

Published on Thu Feb 17, 2011

Question: Our pain management specialist performed a left medial branch block at the L5 vertebrae and L5 dorsal ramus, plus a Bertolotti joint injection. The provider recommended that we report 64493-LT and 64494-LT. I don't think this is correct since the Bertolotti joint is a "pseudo" joint. What is the best choice?Answer: You are correct in stating that the Bertolotti joint isn't a true paravertebral facet joint " it's a congenital anomaly when the transverse process of the L5 vertebra becomes larger than normal on one or both sides and fuses to the sacrum, ilium, or both. Check with your physician to determine whether 20605 (Arthrocentesis, aspiration and/or injection; intermediate joint or bursa [eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa]) or 22899 (Unlisted procedure, spine) more accurately describes the Bertolotti joint injection. Remember to include 756.15 (Fusion of spine [vertebra], congenital) as the diagnosis for Bertolotti syndrome.Lumbar choice: [...]
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