Steroid Injection

Question:

How do I code a left hip intraarticular steroid injection under fluoroscopic guidance?

Answer:

You would report CPT 20610 (Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa); without ultrasound guidance) for the injection and CPT 77002 for the fluoroscopic guidance which can be reported in addition to the injection.

*This response is based on the best information available as of 05/17/18.

Coding for Paravertebral Blocks

Question:

What are the codes 64461-64463 used for?

Answer:

These codes are used to treat acute and chronic pain which includes thoracic pain after mastectomy or multiple rib fractures.  The block (paravertebral or paraspinous) targets the intercostal and spinal nerves and branches.  CPT 64461 is used for a single injection and 64462 is the add-on code for the second and any additional injection site.  Code 64463 is used for continuous infusion by catheter.  Imaging guidance is included and CPT code 64462 can only be reported once per day.

*This response is based on the best information available as of 03/29/18.

Spinal Hardware Block

Question:

How is a spinal hardware block coded?

Answer:

There is not a specific CPT code for a spinal hardware block.  Use an unlisted code 64999. When reporting an unlisted code to describe a procedure or service, it is necessary to submit supporting documentation with the claim to provide an adequate description of the nature, extent, and necessity for the procedure; and the time, effort, and equipment necessary to provide the service.

*This response is based on the best information available as of 03/15/18.

Coding Transforaminal Injections

Question:

How would you report a left lumbar transforaminal epidural injection (Left L5-S1 and left S1) with fluoroscopic guidance?

Answer:

This is reported as 64483 for the first lumbar level (L5-S1) and + 64484 for the additional level (S1). The fluoroscopy is included.

*This response is based on the best information available as of 11/30/17.

EMG Guidance with Extremity Chemodenervation

Question:

How many times can code 95874, Needle electromyography for guidance in conjunction with chemodenervation, be reported If chemodenervation is performed on four extremities (e.g., 64642, 64643, 64644, 64645)?

Answer:

Per CPT, code 95874 is reported for each corresponding chemodenervation of the extremity.  In the example, four chemodenervation codes were reported, therefore, the needle electromyographic (EMG) add-on code 95874 would be reported four times for the scenario described in the Question:.

Source:CPT Assistant October 2014

*This response is based on the best information available as of 10/05/17.

Denials – Chemodenervation of the Facial Nerves for Migraine

Question:

We are getting denials for code 64615 chemodenervation of the facial nerves for migraine headache. Any suggestions?

Answer:

Code 64615 is reported for chemodenervation of muscle(s) innervated by facial, trigeminal, cervical spinal, and accessory nerves, bilateral (e.g., for chronic migraine). Per CPT, code 64615 is used to report a chemodenervation injection procedure specifically for the treatment of chronic migraine. To report this code, the following criteria must be met:

• 15 or more days of headache or a headache that lasts 4 hours or more per day, prior to treatment.

• Treatment must include, 31 injection sites over 7 muscle groups are typically identified on the face, head, neck and upper back (the frontalis, corrugatore, procerus, occipatlis, temporalis, trapezius, and cervical paraspinal muscle groups). The code is reported once, for injection of these sites. Ultrasound guidance may be reported with these codes using 76942.

If this procedure is performed and reported accurately (as described above), appeal the denial with appropriate documentation.

*This response is based on the best information available as of 06/22/17.