Question Question on coding 64484 for second TFESI


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There's some confusion regarding TFESIs (64483 and/or 64484) performed by a PMR provider to treat pain caused by lumbar radiculopathy. Sometimes he performs bilateral TFESIs at a single level (such as L3) which would be 64483-50. However, when done unilaterally, it appears that the anesthetic and steroid are usually injected at two levels under fluoroscopic guidance, but I'm not totally clear on this. The note typically indicates a procedure heading of something like "L4 and L5 transforaminal epidural steroid injection" with indication in the body text of "areas" injected and "needles" placed (note the "s" for plurality) while when he does this at just one level bilaterally, these terms are documented in the singular. The doctor tells me that they are two levels, where "L4" is associated with the L4-L5 neuroforamen and "L5" goes to L5-S1. I also read about the difference between the conventional vs. the preganglionic approach to TFESI, but either way, I'm hoping to get some clarification as to whether the aforementioned documentation is sufficient to report +64484 in addition to 64483 (with the appropriate laterality modifier) or whether the provider's documentation should be restructured to separate out the details for each TFESI if in fact they are two. Thanks to anyone for any insight on this.