Transforaminal Epidural Injection

Question:

If I perform a transforaminal epidural injection of L4-L5 on both sides can I report CPT 64483 twice?  Also, when I use fluoroscopic guidance can I report that separately?

Answer:

If you perform a bilateral transforaminal epidural injection (64483) you can report CPT 64483 with Modifier 50 (bilateral procedure).  Some payors require CPT 64483-single level (1 side) and 64483-50 (the other side) whereas some payors may require RT/LT.  It is important to check with your payor regarding reporting requirements.  Fluoroscopic guidance is included in the descriptor of CPT 64483 (Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level) and cannot be submitted for separate payment.

*This response is based on the best information available as of 3/28/19.

Botox Injection in the Hand

Question:

I am trying to find a CPT code for a Botox injection in the right hand, and found CPT code 64653.  Is this the code I should report?

Answer:

There is not a specific CPT code for a Botox injection (chemodenervation) of the hands.  You should report the unlisted code CPT 64999 when performing the injection(s) on the hands and/or feet. Do forget to use a J code to report the Botox injected.

*This response is based on the best information available as of 3/14/19.

Ultrasound Guidance with a Carpal Tunnel Injection

Question:

When performing a carpal tunnel injection (20526) using ultrasound, what do I need to document to support reporting 76942?

Answer:

In order to report ultrasonic guidance using CPT code 76942 a permanent image of the ultrasound must be maintained.  It is recommended that you document the imaging guidance in a separate paragraph in the procedure note. Don’t forget medication (J code) can be reported separately for the injection.

*This response is based on the best information available as of 1/31/19.

E/M on Same Day as an Injection

Question:

My pain management physician saw a patient in the office and the chief complaint states that the patient is here for a trigger point injection (20552).  He has documented a detailed history, expanded problem focused examination and the decision making is low complexity since the patient is established and the pain is worsening.  Can I bill 99213-25 and the trigger point 20553 together?

Answer:

In order to report an E/M service with Modifier 25 on the same day as another procedure or service the service must be separately identifiable and goes above and beyond the preoperative work for the injection, an E/M can be reported if the patient’s condition required a significant E/M service on the day a procedure or service identified by a CPT code was performed.

• Above and beyond other service provided
• Beyond the usual preoperative and postoperative care associated with the procedure that was performed
• Different diagnosis is not required

However, based on the reason for the visit, “patient here for trigger point injection”, and the intent of the visit is the injection, the E/M service is included in the preoperative workup and not reported separately. Keep in mind there is an Inherent E/M service in every procedure.

*This response is based on the best information available as of 12/13/18.

Thoracic Nerve Blocks

Question:

If I perform three separate injections at three intercostal levels can I report 64420 and 64421 x 2?

Answer:

No you should report 64421 (Injection, anesthetic agent; intercostal nerves, multiple, regional blocks). CPT code 64420 is used for a single injection and CPT 64421 is reported for multiple intercostal nerve blocks even when the injections are at three levels.

*This response is based on the best information available as of 06/28/18.

Piriformis Syndrome

Question:

What code do I use when my physician injects the piriformis muscle for piriformis syndrome under ultrasound guidance in the office? Do I report 64445 for the nerve injection?

Answer:

CPT code 20552 and 76942 for the ultrasound guidance. Per CPT Assistant April 2012; there is a significant difference in the work and procedure, as well as intent, between an injection of the piriformis muscle and the perineural injection of the sciatic nerve. The sciatic nerve injection code (64445) should not be used to report a piriformis injection. Piriformis muscle injection(s) should be reported using CPT code 20552, Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s).

*This response is based on the best information available as of 06/14/18.