Hardware Block Injection


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I work in a pain management practice and when we do hardware block injections we bill 64999, unlisted procedure nervous system. We send supporting documentation with the claim or shortly after the claim is received and typically do not have any issues getting reimbursed.

Recently a coworker said that she believed code 22899, unlisted procedure spine, would be more appropriate. So I have been doing a bit of research and I know that the CPT assistant suggests that the most appropriate code to report is 64999. I was wondering if someone could explain why 64999 would be more appropriate than 22899. And do you have any examples of what one might bill a 22899 for? Thank you in advance for your insight!


True Blue
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I would believe if the AMA has published through CPT Assistant that CPT 64999 "would be the most appropriate...", I would think that if you look at other pain management procedures which fall under codes that are unlisted per the AMA, they typically suggest 64999 as the unlisted code to be used for those procedures; as well, considering since it more similar to a nerve block procedure versus spine surgery procedure as seen with other unlisted listed where 22899 is typically used for unlisted spine surgery procedure recommendation.

AMA CPT Assistant May 2012
Surgery: Nervous System
Question: What code(s) may be reported for injection of 0.5% Marcaine and 80 mg of Depo-Medrol to existing spinal
hardware (eg, pedicle screws) at L4, L5, and S1 bilaterally?
May code 64483 be reported?

Answer: No. Code 64483, Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level,
represents transforaminal epidural nerve root injection performed in the lumbar region. There is no specific CPT
code for the injection of spinal hardware. CPT code 64999, Unlisted procedure, nervous system, would be most appropriate
to describe the injections for pain performed outside the foramen, as indicated in the clinical scenario provided
in this inquiry. Although three spinal level (L4, L5, S1 bilaterally) injections were performed, code 64999 should
be reported only once to represent the multiple injections.
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Phoenix, AZ
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I am curious, what do you use as a comparison code for the 64999, do you use 64483 as the comparison to get paid for the hardware block injections or do you use another code?