Neurosurgery Coding Alert

Question: The neurosurgeon administered two injections to block the median branch nerve inside the joint. Can I report two injections for this procedure?


Arizona Subscriber

Answer: No, you cannot report two injection codes for the procedure you describe. If the neurosurgeon provides more than one injection at the same spinal level and on the same side of the spine, you should only report a single unit of service.

In the case you describe, the physician administered two injections because one branch of the nerve sits at the top of the facet joint and a second branch sits at the bottom. The code descriptors for 64470-64476 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve -) specifically note -single level,- not -per injection.-

Example: Two injections for a nerve block at T1/T2 and two more at T2/T3 equals only two levels, although the physician administered a total of four injections. Therefore, you should report 64470 and 64472.

Bilateral difference: When the neurosurgeon provides multiple injections on different sides of the spine at the same spinal level, payers will allow you to claim a bilateral procedure (and receive additional compensation) by appending modifier 50 (Bilateral procedure) to the appropriate facet joint injection code.

For example, if the physician injects the left and right side at T6/T7 and T7/T8, you should report 64470-50 (for the initial bilateral injection at T6/T7) and 64472-50 (for the additional bilateral injection at T7/T8).