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Thread: 64493,64494,64495

  1. #1

    Default 64493,64494,64495

    When billing for a facet can you bill 64494 at 2 units or should you bill as 64493,64494,64495?? Please help, thank you

  2. #2
    Join Date
    Apr 2007
    Location
    St. Joseph County, Indiana
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    Default

    Just one 64494.

    64493 - 1st level - one unit
    64494 - 2nd level - one unit
    64495 - All levels at that...at one unit

    Brock Berta

  3. #3
    Join Date
    Apr 2007
    Location
    Santa Rosa
    Posts
    51

    Default

    Quick question...(new to Pain Management) how is the level determined? L3-4 = 1 level? Or is it L3 and L4 are each 1 level?

  4. #4
    Join Date
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    ".....refer to the injection of a facet joint either by injection into the joint with one needle puncture or by anesthetizing the two medial branch nerves that supply each joint (two needle punctures). For example, a left-sided L4-L5 intra-articular injection performed with a single needle puncture would be coded as 64475. Injection of the L3 and L4 medial branch nerves supplying the L4-L5 facet joint would also be coded as 64475, even though two separate injections are performed to effect the same result."

    Above is from CPT Assistant 2004 and below from 2010

    August 2010 page 12
    Surgery: Nervous System, 64490, 64491, 64492 (Q&A)

    Question: Lumbar medial branch blocks were performed on the right at L3, L4, and L5. Would codes 64490, 64491, and 64492 be reported because three different levels were injected?

    Answer: No. The L3, L4, and L5 medial branch nerves innervate the L4-L5 and L5-S1 facet joints. Therefore, code 64493, Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level, is reported for the first joint injected or blocked (L4-L5). Code 64493 is reported for a single or initial level treated. Add-on code 64494, Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure), is reported for the second joint or level injected or blocked (L5-S1). In this specific instance only, CPT codes 64493 and 64494 should be used, provided the injections were performed in the lumbar spine with fluoroscopic (or CT) guidance, as required to use codes 64490-64495.

    To further clarify, add-on code 64495, Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure), is reported only once per day for injections at the third and any additional lumbar or sacral level(s) treated (which does not apply to this case). Codes 64494 and 64495 should only be used in conjunction with code 64493.

    CPT codes 64490-64492 are reported in the same way for cervical-thoracic facet injections or blocks. In addition, add-on codes 64492, Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; third and any additional level(s) (List separately in addition to code for primary procedure) and 64495 are reported once per day as a singular line item irrespective of the number of spinal levels treated.


    --------------------------------------------------------------------------------

  5. #5

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    I have a provider who is trying to bill 64493, 64494, 64495, 64495 (51), 64495 (51).
    We are going round and around as I didn't think this could be billed like this but I was trying to find it in black and white as far as what Medicare will accept.

    Thank you for any help with this.
    Margaret

  6. #6
    Join Date
    Apr 2007
    Location
    Baton Rouge
    Posts
    1,124

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    2017 ICD-10-CM Coding Book
    Quote Originally Posted by molvera View Post
    I have a provider who is trying to bill 64493, 64494, 64495, 64495 (51), 64495 (51).
    We are going round and around as I didn't think this could be billed like this but I was trying to find it in black and white as far as what Medicare will accept.

    Thank you for any help with this.
    Margaret
    64495 (and also 64492 for the cervical equivalent) can be billed only once per day, per the CPT descriptor "third and any additional level(s)". There is also a notation directly beneath each of these in the CPT book "Do not report 64495 more than once per day". Medicare has a little about these codes in this LCD (for Novitas); search your MAC's LCD also for specific guidance.

    http://www.cms.gov/medicare-coverage...AAAAAAA%3d%3d&

    Hope this helps!
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

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