Coding Transforaminal Epidural – Questions

Here’s an interesting question from one of my blog followers.

Coding Transforaminal Epidural Nerve Root Block 

Scenario and Question:  

This is what she emailed me – “Nerve root block was performed on RT side of L4,L5,S1. They gave me CPT codes 64483 64484 64484 77003 dx 724.4 in the superbill.  I coded 64483, 64484-RT-L4-L5, 64484-RT-L5-S1,77003 724.4 and it was billed by the biller. But the Client is asking to Please review coding /modifier.

“My client is from a billing company he may not know the coding guideline. He appended 51 modifier for 64484 and rebilled. as per guideline 51 should not use with 64484. My Head operation manager says me the client was really upset with this and they think we are not sure of what we are doing?” So what do you think?

 

 

 

Let’s Define these Codes first. Per CPT Description:

 

64483 Injection(s), anesthetic agent and/or steroid, transforaminal epidural; with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level +64484 -lumbar or sacral, each additional level (list separately as add-on code for primary procedure)

Here are my Comments and my Recommendations on how to Properly code and bill for this scenario is as follows:

Right Transforaminal Injection / Nerve Root Block at L4-L5-SI

Rationale:

Spinal Nerve L4 (interspace L4-L5 ) Spinal Nerve L5 (interspace L5-S1) Spinal Nerve S1 (foramen)

Here are your billing and reimbursable Codes for  Coding Transforaminal Epidural Injection:

64483-RT                1 unit 64484-RT                2 units

  * 64483 is the 1st level

+ 64484 is an add-on code – Modifier -51 on this code is not allowed because it is an “add-on” code! – it is NOT  stand-alone code.

***** You don’t bill for the fluoro 77003 because they are bundled! – “….. with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level”

 

Are L4, L5, S1 modifiers? NO, they are not modifiers and you don’t append them on your codes. There are spine levels right. How can we append these as modifiers ? “

Client corrected this account by using 51 modifier.” — not a good idea!

Read more about Pain Management Procedures. Understand them so you can get a bigger picture on how these procedures are performed by your physician. CLICK and READ HERE!

Reference Source:  They are all defined and stated from the Local Coverage Determination (LCD): Transforaminal Epidural, Paravertebral Facet and Sacroiliac Joint Injections (L27512) – Revision Effective Date For services performed on or after 09/01/2014 CPT Code Book 2011, 2012, 2013, 2014 and CPT Assistant Publications from the AMA Additional Reading Source: ( Books published by Laxmaiah Manchikanti, MD )

Principles of Documentation, Billing, Coding & Practice Management for the Interventional Pain Professional. 2004

Interventional Pain Management: Low Back Pain – Diagnosis and Treatment. 2002

Interventional Pain Management: Documentation, Coding, and Billing – A Practical Guide for Physicians and ASCs. 2002