Wiki 64492 & 64495

[AimeeA10]

There has been some confusion in our office as to how to bill these two codes. According to the CPT book you should only report these two codes once per day but others in the practice think it is acceptable to code them multiple times.

Example:
Dr. Zzz did 5 Left Cervical Facet Injections.
The question is would we bill it like this:
64490 -LT
64491 -LT
64492 -LT
Or like this:
64490 -LT
64491 -LT
64492 -LT (x3)

Any opinions and resources other than the CPT book would be greatly appreciated.

 

[mhstrauss]

There has been some confusion in our office as to how to bill these two codes. According to the CPT book you should only report these two codes once per day but others in the practice think it is acceptable to code them multiple times.

Example:
Dr. Zzz did 5 Left Cervical Facet Injections.
The question is would we bill it like this:
64490 -LT
64491 -LT
64492 -LT
Or like this:
64490 -LT
64491 -LT
64492 -LT (x3)

Any pinions and resources other than the CPT book would be greatly appreciated.

This is the appropriate way to code your example:
64490 -LT
64491 -LT
64492 -LT

The CPT book should be the only resource needed, as it states right there under the code "Do not report 64492 more than once per day"...which unfortunately means the doc will only get paid for 3 levels per day. I definitely feel your frustration with this; we do these injections often, and I've yet to find any documentation that shows we can bill anything more than the 3 levels

 

[donnajrichmond]

If the CPT book isn't enough, I don't know what will be, but try CPT Assistant February 2010 - "Add-on codes 64492 and 64495 are reported once as a single line item, irrespective of the number of spinal levels beyond two that are treated."

The code description is "third and any additional level(s)", not "each additional level" as the description was in the codes before 2010 (64472 and 64476).

 

[AimeeA10]

Thanks to you both. Yes it is definitely frustrating but I wanted multiple opinions to back me up. Thanks again for you help!

 

[dwaldman]

Also remember medial branch blocks are commonly performed which fall under 64490-64495, instead of blocking the joint with an intraarticular injection, the physician blocks the two medial branch facet joint nerves that innervate that joint.

So C2,C3,C4,C5,C6 medial branches blocked would innervate C2-C3, C3-C4, C4-C5, C5-C6 so this would only be 4 facet joint levels. The codes are set up to bill per facet joint level not per nerve blocked. For example in CPT Assistant, they describe L3,L4,L5 medial branch block, the response is that these facet joint nerves provide innervation to the L4-L5, L5-S1 levels, so 3 injections but only two levels reported----64493, 64494.

The final code 64492 or 64495 include a third level blocked and any additional levels that are treated (ie, 4th or 5th). The codes are reported with quanity one and then with the appropriate modifier RT, LT, or 50.

Working with the physician to determine that type of block performed (medial branch nerve or joint), when he describes for example, C3, C4,C5 blocked is he describing the anatomical location of the injection or the actual medial branch nerve that he is blocking. If typically performs medial branch blocks, you can explain to the physician that the reporting is per facet level and it could prove beneficial to the coder/biller and to the payer for clear documentation such as L2, L3, L4, L5 medial branches /dorsal ramus were blocked at anatomical locations L3, L4, L5, and sacral ala corresponding to the L3-L4, L4-L5, and L5-S1 facet levels.