I think without information from the AMA CPT Assistant on your direct question there are certain things that have to be pieced together.
One thing that I noticed is a common rule with codes 64490-64495 is that if you are performing an intraarticular block and also blocking the medial branches of that level you only report for that level once, with that in mind, I would use that concept with the blocking of the lateral branches of the posterior primary rami at S1â€“S3, and the L5 dorsal ramus (L5DR). with intraarticular SI Joint injection. I personally wouldn't also separately report 27096 if you are billing 64450 x 4 for the L5 w/S1 thru S3 lateral branches that are innervating the joint.
Below is from CPT Assistant December 2009 where they give an example of a neurolytic block--- using the 64450 companion code-- 64640, as a appropriate to report for this type of individual nerve destruction treatment. If they don't accept this comparison concept might need to use an unlisted code, with the bundling of 77003 into 27096 descriptor in 2012 and the bundling into 64633, I would potentially forgo reporting 77003 if you are going to try to rebill or bill in the future.
I would bill as
64450-51 LT ( x 3)
L5 with S1 thru S3 Lateral branch injections
"To differentiate between the work when performing sacral nerve destruction of S1, S2, S3, and S4, each individually separate peripheral nerve root neurolytic block is reported as destruction of a peripheral nerve, using code 64640, Destruction by by neurolytic agent; other peripheral nerve or branch. In this instance, code 64640 is reported four times. It is suggested that Modifier 59, Distinct Procedural Service, be appended as well."
- ICD-10 Trainings
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join