Wiki Coding Paravertebral Injections from L3-S1, Need professional opinion

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Paravertebral facet joint injections from L3-S1 is very confusing to me- because L3-L4, is one level of nerves, L4-5 is another and L5-S1 is another so is that not 3 levels? If its not an example of 3 levels injected than what is?

specifically with ultrasound guidance 0216T lumbar or sacral, single level +0217T for second level, and +0218T for third level

I understand the nerves from the previous levels innervate with the levels below but how is L3-S1 anything but 3 levels?

Also on the AAPC website they give an example, (given it is for Fluoroscopic guidance but I believe it still applies) Under fluoroscopic guidance, bilateral facet joint injections at L3-L4 and L4-L5. Report codes 64493-50 (first level, bilateral) and 64494x2 (second level, bilateral). So given that official AAPC example- wouldn't going down to S1 mean another level?

Thank you so much in advance for any guidance on this!
 
Yes that is three levels of joints. L3-4, L4-5, L5-S1. But, are you asking because a third level is being denied on a claim, or why?

Maybe this would help?
"For CPT codes 64492 and 64495, the need for a three-level procedure may be considered under unique circumstances and with sufficient documentation of medical necessity on appeal."

"One to two levels, either unilateral or bilateral, are allowed per session per spine region (i.e., two (2) unilateral or to two (2) bilateral levels per session)."
"Codes 64492 and 64495 will only be covered upon appeal if sufficient documentation of medical necessity is present."

"Q1: Is a patient allowed four diagnostic and four therapeutic injections in a rolling 12 months?
A1: Correct. Four diagnostic and four therapeutic injections are allowed in a rolling 12-month period for CPT 64490, 64491, 64493, 64494. CPT 64633-64636 only allow two sessions in 12 months, 64492 and 64495 are only allowed on appeals basis."

 
Hi there,
Yes, levels for facets with ultrasound are counted the same way.
 
Yes that is three levels of joints. L3-4, L4-5, L5-S1. But, are you asking because a third level is being denied on a claim, or why?

Maybe this would help?
"For CPT codes 64492 and 64495, the need for a three-level procedure may be considered under unique circumstances and with sufficient documentation of medical necessity on appeal."

"One to two levels, either unilateral or bilateral, are allowed per session per spine region (i.e., two (2) unilateral or to two (2) bilateral levels per session)."
"Codes 64492 and 64495 will only be covered upon appeal if sufficient documentation of medical necessity is present."

"Q1: Is a patient allowed four diagnostic and four therapeutic injections in a rolling 12 months?
A1: Correct. Four diagnostic and four therapeutic injections are allowed in a rolling 12-month period for CPT 64490, 64491, 64493, 64494. CPT 64633-64636 only allow two sessions in 12 months, 64492 and 64495 are only allowed on appeals basis."

I really appreciate your time. And yes I did find those articles in my search. However, I have found different opinions on how L3-S1 should be reported. Most were saying two but that doesn't make sense as every facet joint has a medial nerve around it. I'm just curious if you specifically have billed for this procedure? It would put my mind at ease. I am just studying and a few sources (not AAPC) had a practice question regarding this but they say its 2 levels. Also, out of sheer curiosity (and wanting to be as accurate coder as possible) I was looking into this. I just couldn't get it off my brain. Thank you so much again!
 
I really appreciate your time. And yes I did find those articles in my search. However, I have found different opinions on how L3-S1 should be reported. Most were saying two but that doesn't make sense as every facet joint has a medial nerve around it. I'm just curious if you specifically have billed for this procedure? It would put my mind at ease. I am just studying and a few sources (not AAPC) had a practice question regarding this but they say its 2 levels. Also, out of sheer curiosity (and wanting to be as accurate coder as possible) I was looking into this. I just couldn't get it off my brain. Thank you so much again!
Ah okay I see. I would have to see the source and reasoning behind saying it's only two. It depends on the code description for the spine procedure and whether it is per level, segment, joint, or interspace, etc.. Which one said two? I would be interested to see the source and question. Maybe they were talking about medial branch blocks? And, it depends on the provider's documentation whether it has a dash or comma between such as L4-5 or L4, L5.
Yes, I have billed these procedures and lots of other PM&R injections and spine surgery.

This site has a good explanation, I am not sure the date it was written but the explanation is good.
"Standard documentation lists the facet joint to be blocked with hyphens.
Example A: L4-5 or L4-L5
Coding: Each facet joint = one level code. CPT code is 64493"
 
Paravertebral facet joint injections from L3-S1 is very confusing to me- because L3-L4, is one level of nerves, L4-5 is another and L5-S1 is another so is that not 3 levels? If its not an example of 3 levels injected than what is?

specifically with ultrasound guidance 0216T lumbar or sacral, single level +0217T for second level, and +0218T for third level

I understand the nerves from the previous levels innervate with the levels below but how is L3-S1 anything but 3 levels?

Also on the AAPC website they give an example, (given it is for Fluoroscopic guidance but I believe it still applies) Under fluoroscopic guidance, bilateral facet joint injections at L3-L4 and L4-L5. Report codes 64493-50 (first level, bilateral) and 64494x2 (second level, bilateral). So given that official AAPC example- wouldn't going down to S1 mean another level?

Thank you so much in advance for any guidance on this!
Would the fact that they're using Ultrasound guidance be the reason for denial? Here is what I find on the CMS policy:

Limitations

  1. Facet joint interventions done without CT or fluoroscopic guidance are considered not reasonable and necessary. This includes facet joint interventions done without any guidance, performed under ultrasound guidance, or with magnetic resonance imaging (MRI).
 
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