Injection plus catheter insertion in lumbar area with twice daily injections - Guidance?


Vincennes, IN
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that is a terrible title, I'm sorry!

I am new to Pain Management, and we have a provider who is performing injections in the lumbar area. He inserts a catheter, injects medication, then leaves the catheter in place for 4 days. Patient comes back into the office twice daily for injections. My supervisor thinks that a 64520 is the best fit, and to charge it daily. With the actual work being completed only on the 1st day, with subsequent injections only, I'm not sure.

Can anyone guide me in the right direction?
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Hi there. I agree that reporting a code that does not represent the work/expense involved in the procedure performed is not a good idea. Maybe asking him to compare his documentation for the first procedure - putting the catheter in place - to the follow up procedures could be a good way to illustrate the difference. Also ask him to consider the materials used for the first vs. the follow up procedures.

I found the following plain-English description for 64520 that may help.

The level of the blocks is determined, and the superior aspect of the spinous process is identified and marked. A needle entry site is marked approximately 2.5 cm lateral to the superior aspect of the spinous process. A local anesthetic is injected at the planned needle insertion site. A spinal epidural needle with tubing attached to a syringe is then inserted through the skin and advanced until contact is made with the transverse process. The needle is then withdrawn to the subcutaneous tissue and angled so that is can be walked off the lower (caudad) edge of the transverse process. The needle is reinserted and advanced into the paravertebral space. The needle is aspirated to ensure that it is not in the spinal canal or a blood vessel. The anesthetic is injected.
A more detailed description (complete with a lot of images, CW - blood) is here: