Genicular Nerve RFA

Question:

I’m new to coding. What code would I use for radiofrequency ablation of the genicular nerve?

Answer:

You’re in luck! There is a new code in 2020: 64624 Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed. The code includes destruction (e.g., chemical means, radiofrequency ablation) of all branches of the genicular nerve including the the superolateral, superomedial, and inferomedial genicular nerves. CPT 64624 also includes fluoroscopic/imaging guidance so you would not report a separate radiology code (7xxxx).

*This response is based on the best information available as of 05/29/20.

Fluoroscopic Guidance and Trigger Point Injections

Question:

I would like to know if generally speaking if Medicare pays for trigger point injection CPT code 20552 with imaging guidance? If yes I would like to know if I can use fluoroscopy or it has to be ultrasound.

Answer:

Medicare as well as other payors should pay for fluoroscopy guidance separately unless they have a medical policy that differs from CPT Trigger point injections do not include imaging guidance and can be reported separately.From CPT Assistant: “The trigger point injection(s) codes (20552 and 20553) are reported once per session based on the number of muscles injected, regardless of the number of trigger points injected in each muscle. Code 20552 is reported for trigger point(s) injection(s) in 1 or 2 muscles, and code 20553 is reported for trigger points injection(s) in 3 or more muscles. If imaging guidance is utilized, report the appropriate radiology code (76942,77002, and 77021) in addition to the injection codes.”

*This response is based on the best information available as of 02/06/20.

Trigger Point Injections Coding: Muscle or Muscle Group

Question:

One of our Providers recently completed Trigger Point injections toBilateralThoracic ParaspinalsandBilateralTrapeziusin the same setting for a patient. When we bill for this procedure do we counteachside(Left and Right) of these procedures as a muscle group to be billed out as 20553 OReacharea(Bilateral or unilateral) of these procedures as a muscle group to be billed out as 20552?

Answer:

Trigger points are by muscle(s) injected; 20552 is 1-2 muscles, 20553 is more than 3 or more muscles.  He injected 4 muscles (2 paraspinal and 2 trapezius) so the code billed is 20553. Additionally, these codes are not reported bilaterally with a 50 modifier or with an RT/LT. Report by the number ofmusclesinjected.

*This response is based on the best information available as of 12/19/19.

Coding Bilateral Percutaneously Placed Spinal Cord Stimulator Electrodes

Question:

If bilateral spinal electrode are placed percutaneously, 63650, can both be reported?

Answer:

Yes, if two electrodes are placed, bilaterally, both may be reported.  See the CPT guidelines below.

Reference: CPT Assistant June 1998

Codes 63650, 63655, and 63660 each describe the placement, revision, or removal of only one electrode catheter or electrode plate/paddle. Placement of any additional electrode catheter(s) or plate(s)/paddle(s) should be separately reported by appending the modifier -51 to the appropriate code.

*This response is based on the best information available as of 12/05/19.

Nerve Repair

Question:

I know that CPT code 64910 is the code I report for a nerve repair of the spine.  My question is when performing this procedure on three levels how to I report this.

Answer:

You would report CPT code 64910 for each level.  Since the second and third levels are bundled under NCCI you would append Modifier 59 to the second and third levels to indicate they are distinct and separate.  Also keep in mind the maximum number of levels you can bill on the same date of service for Medicare is 3.

*This response is based on the best information available as of 5/23/19.

Lumbar Sympathetic Plexus Block

Question:

I am new to pain management and am trying to find the correct CPT code for a lumbar sympathetic plexus block. Can you help?

Answer:

The correct CPT code is 64520 (Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic).

*This response is based on the best information available as of 5/9/19.