Orthopedic Coding Alert

Question: 1. A patient was given an injection at C-7 cervial region, T-2 thoracic region, L-1 lumbar region and S-1 sacral region. Would the appropriate charge be 64440 x 4 units because a single level injection was given in four regions? The patient is given an injection on the right side at S-1 and on the left side at S-1. Would the appropriate charge be 64440 RT and 64440 LT, or does the vertebral level include both the right and left injections?

2. A patient is given injections at C-7, C-6, C-5 cervical region and L-2, L-3, L- 4, L-5 lumbar region. Would the appropriate charge be 64441 x 2 units because multiple vertebral levels were injected in two different regions?

University Orthopaedic Clinic, P.C., AL


Answer: In both of these situations, to bill for more than one injection on a specific date will likely result in a denial and could result in an audit, even if multiple injections are performed.

1. Code 64440* (paravertebral nerve [thoracic, lumbar, sacral, coccygeal], single vertebral level) does not allow for distinction for left or right or both. To do so would be unbundling. This is a starred procedure so use of a modifier for multiple levels or multiple procedures would not be allowed.

2. Code 64441* (paravertebral nerves, multiple levels [eg regional block]) is also a starred code, which would not allow for billing separately for multiple injections on the same date. To do so also would be considered unbundling and would not be allowed.