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Wiki TF ESI (64483) and Facet Injection (64493)

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stonecm

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Does anyone have any updated information regarding billing a TF ESI with a facet injection? I read posts from 2010 that say that is not typically done because the facet injection is diagnostic and the TF ESI defeats the purpose, but I was hoping to get updated information. I do not see any CCI edits that say the two can't be billed together.

Also, does anyone have information regarding how many levels of either procedure can be billed for one date of service? For example, I don't believe more than 3 levels of facet injection can be billed on the same day, but could we bill 64483, 64484, 64493, 64494?

Thanks in advance!
 
I would review the LCD for the Medicare carrier you are billing. For example, if they state there should be presence of radiculopathy for the transforminal epidural but not a strong radicular component for the indication for the facet block, then if they state that facet, SI joint, epidurals should not be performed during the same setting. The next step is to present this information to the physician. And suggest addressing different spinal conditions that have different treatment options in separate encounters.
 
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