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64490 debate - your thoughts?

  1. #1
    Columbus, OH
    Question 64490 debate - your thoughts?
    Medical Coding Books
    We have a debate going on in our office in regards to code 64490. When a physician performs a medial nerve branch block he has to inject the medial nerve above and below the facet joint he's wanting to affect. The debate comes into play when we're deciding how many levels to code.

    For example: The patient has symptoms in the L4-L5 facet joint. The physician injects the medial nerve at L4 and the nerve at L5.

    Do you code 1 level for the joint (L4-L5) affected? code 64490
    Do you code 2 levels for the 2 injections (L4 & L5) given? code 64490 and 64491

    Any feedback would be greatly appreciated!!!


  2. #2
    According to Noridian, "For the purposes of this policy, a facet joint “level” refers to the zygapophyseal joint or the two medial branch nerves innervating that zygapophyseal joint.".

    So you would code this as one level and since it is the Lumbar L4-L5, the code would be 64493. 64490 would be for cervical or thoracic single level.
    Peggy Y, Green, CPC, CPMA, CPC-I, CRC
    "To love what you do and feel that it matters - how could anything be more fun?" Katharine Graham

  3. #3
    Columbus, OH
    Thanks!! Sorry about the level confusion. I just grabbed the first code for this procedure and made up the example without paying attention to the level . Hopefully my brain will function better today.

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