Neurology & Pain Management Coding Alert

Question: Can we bill on the same day for both a medial branch block and a facet injection?

West Virginia Subscriber

Answer: Both of these injections are represented by codes 64490-64495 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT] …). Codes within the family are distinguished by injection site (lumbar/sacral or cervical/thoracic) and the total number of facet joint injections administered to the site (first, second, or third/additional level).

The number of allowable codes for the encounter depends on the circumstances. If your provided administered the medial branch block and intra-articular facet joint injection for the same facet joint level, you should only report one code for the facet joint injection. The code descriptors clearly indicate that the codes include both approaches (injections to the joint or nerves innervating that joint).

Example: A physician performed right C5 and C6 medial branch blocks as well as a right C5-C6 intra-articular facet joint injection. You’ll report 64490-RT (Right side) with 1 unit of service.

Each code represents a unilateral procedure reported once for each injection at that specific nerve branch level, regardless of the number of needle(s) inserted or number of drug(s) injected at that level. If your provider administers bilateral injections to a level, append modifier 50 (Bilateral injection) to the appropriate procedure code.