Neurosurgery Coding Alert

Question: How should I report bilateral paravertebral articular nerve blocks for Medicare and Medicaid claims?

Oregon Subscriber
 
 Answer: The appropriate codes, introduced in CPT 2000, are 64470-64484. For instance, if the nerve block occurs at the cervical level, report 64470 (injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level) for the first level and 64472 for each additional level. These codes describe unilateral procedures and require that modifier -50 (bilateral procedure) be appended if they are performed bilaterally.
 
For bilateral procedures, some carriers prefer that the charge be listed on one line of the claim form. For instance, for a bilateral nerve block on two cervical levels, report:
 64470-50
 64472-50.  
Other carriers may want the charges listed on two lines:
 64470
 64470-50
 64472
 64472-50
 
Although they are not needed, HCPCS modifiers -LT and -RT (left side/right side) indicate that you are using a "two-line" technique for billing bilateral procedures:
 64470-LT
 64470-50-RT
 64472-LT
 64472-50-RT  
Check with the individual carrier for its billing requirements before submitting the claim. Remember that add-on codes 64472, 64476, 64480 and 64484 must be reported in addition to the code for the primary procedure and are not subject to multiple-procedure payment reductions.
 
According to CPT, if fluoroscopic guidance and localization is used for needle placement and injection with 64470-64484, report 76005 (fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures) in addition to the code(s) for the injection(s).