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Thread: Need help coding pain management injections

  1. #1

    Default Need help coding pain management injections

    AAPC: Back to School
    We are having a bit of confusion on how to code the following: Can someone help with this? I would like to know how it should be coded in both the physician office and the ambulatory surgery setting if possible. Thank you!
    Facet joint intra-articular injection at (L3-4, L4-5 and L5-S1 levels bilaterally), along with associated medial branch blocks After risks and benefits were reviewed, consent was obtained. The patient was taken back to our surgical suite and laid in the prone position. The mid back was sterilely prepped and draped in a typical fashion. The vitals were monitored throughout the entire procedure. Under flouroscopy, strict aseptic conditions, local anesthesia and standard protocols, mid back over the maximum axial tenderness is identified and coorelated with imaging study and levels of pain producing facet joint were identified , and selected lumbar facet joints were injected at (L3-4, L4-5 and L5-S1 levels bilaterally) is performed with (10 mg) of Methylprednisone along with 2cc of 1% Lidocaine at each of these levels. During injection of the medication patient's axial pain appeard to be reproduced. (Isouve-200, contrast dye was used to localize the intra-articular joint and to make sure that there is no spread of the medication intra-vascularly or intraduraly). Patient tolerated the procedure well.

    It was coded with only two levels, but I believe it should be three. Our physician went to a seminar and was told to always subtract a level. Thank you!!!!
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  2. #2


    It's definitely 3 levels that were injected.
    For the ASC I would code 64475-50, 64476-50, and 64476-50.
    Hope that helps

  3. #3
    Join Date
    Apr 2007


    I agree with Bella for the most part. Depending on the carrier, you may need to use RT/LT instead of the 50 modifier. More and more carriers are wanting these broken out into line items.
    Mary, CPC, CANPC, COSC

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