I think it is oppurtunity to relay to the physician that although 64493 was selected on the superbill, recent published Q and A from AMA CPT Assistant states this is an unlisted procedure. And the physician can confirm what he feels is an accurate compare code in terms of work/time to perform, risk of complications with the procedure, and anatomical location of procedure.
May 2012 page 14
Frequently Asked Questions: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.