Clarifying Nerve Injection Coding: CPT 64451 vs. 64450

Question:

Hi KZA, I am new to pain management coding. If I’m injecting the L5, S1, S2, and S3 nerves, do all four have to be injected in order to report code 64451 appropriately? Could code 64451 still be reported if only one or two nerves are injected?

Answer:

All four nerves must be injected in order to report code 64451, Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (i.e., fluoroscopy or computed tomography).

The injection targets the L5 dorsal ramus nerve at the junction of the sacral ala and S1 superior articular process. In turn, the S1, S2, and S3 nerves are injected at the posterior lateral foramen of the S1, S2, and S3 foramen. CPT 64451 has an MUE of 1.

If only one or two nerves or branches were injected, code 64450, Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch, may be reported with one or two units, respectively. Follow your individual third-party payor’s guidelines for appropriate modifier usage when each subsequent unit of 64450. CPT 64450 has an MUE of 10.

*This response is based on the best information available as of 4/10/25.

First Visit for a Chronic Condition

Question:

I am seeing a patient for the first time in the office and they are reporting to me that they have had psoriasis for over two years and their symptoms are worsening; is this problem a level 3 (99203) or 4 (99204)?

Answer:

If your documentation indicates the patient has a chronic condition that is worsening, then the complexity of the problem addressed is moderate, even if this is their first visit to you. However, keep in mind there are three elements to Medical Decision Making:

• Complexity of Problem(s) Addressed

• Amount and/or Complexity of Data to be Reviewed or Analyzed

• Risk of Mortality and/or Morbidity of Patient Management

Two of the three elements on the risk table must be met.  For example, if the condition managed is chronic psoriasis worsening and you write a prescription for a topical medication, the complexity of the problem addressed is moderate with moderate risk. This would indicate a level four new patient visit (99204).

*This response is based on the best information available as of 4/10/25.

Destruction of Seborrheic Keratosis

Question:

I have a patient encounter. I need to code for a patient with 3 SK’s, 2 on the right forearm and 1 on the left forearm. The physician froze the lesions. I am thinking I should code 17000 x 1 and 17003 x 2. Is this correct?

Answer:

The correct CPT code to report for destruction of SK’s is 17110 (destruction benign lesions other than skin tags or cutaneous vascular proliferative lesions up to 14). You will only report CPT code 17110 with 1 unit since the code includes 1-14 lesions. CPT codes 17000-17004 is used to report the destruction of premalignant lesions for example an AK (actinic keratosis).

*This response is based on the best information available as of 3/27/25.

Primary Difference in Lumbar Laminectomy Codes

Question:

What is the primary difference between lumbar laminectomy CPT codes 63030 and 63047?

Answer:

The primary difference in use of these CPT codes is the diagnosis; CPT code 63030 is for removal of a disc due to herniation or degenerative disc disease and CPT code 63047 is for decompression of the nerve due to stenosis or spondylosis.

*This response is based on the best information available as of 3/27/25.

Chronic Pain Management G Codes

Question:

I'm struggling to understand the guidelines for HCPCS code G3002 and G3003. Is there any guidance you could provide?

Answer:

CMS's MLN006764 September 2024 provides guidance on the appropriate use of Chronic Pain Management (CPM) HCPCS codes G3002 and G3003. Medicare defines chronic pain as “persistent, or current pain lasting longer than three months.”

The HCPCS codes are used for reporting "chronic pain management” and treatment monthly bundle including:

• Diagnosis

• Assessment and monitoring diagnosis

• Administration of a validated pain rating scale or tool

• Development, implementation, revision, and/or maintenance of a person-centered care plan that includes strengths, goals, clinical needs, and desired outcomes;

• Overall treatment management; facilitation and coordination of any necessary behavioral health treatment;

• Medication management;

• Pain and health literacy counseling;

• Any necessary chronic pain related crisis care;

• Ongoing communication and care coordination between relevant practitioners furnishing care, e.g. physical therapy and occupational therapy, complementary and integrative approaches, and community-based care, as appropriate.

Criteria and documentation requirements

The initial visit must be face-to-face visit for at least 30 minutes provided by a physician or other qualified health professional. 30 minutes must be met or exceeded to bill for G3002.

G3003 can be added for each additional 15 minutes of chronic pain management and treatment personally provided by a physician or other qualified health care professional, per calendar month. The entire 15 minutes must be utilized in to report.

You must develop and maintain a person-centered plan.

You must provide and document the elements listed in the code bundle to the first month for each patient. Subsequent months do not require all listed components.

Although this code was created by CMS, we recommend you reach out to your commercial payors as they may reimburse for them as well.

G3002 is billed once per calendar month. G3003 is billable for as many times as medically necessary within the calendar month and calculated in 15-minute increments.

https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/eval-mgmt-serv-guide-icn006764.pdf

*This response is based on the best information available as of 3/27/25.

Inpatient Consultation Coding for Medicare

Question:

If you see a Medicare patient for the first time in the hospital as an inpatient consultation, what code would you bill for the EM?

Answer:

The EM would be reported as an Initial hospital or observational care codes (99221-99223) with the appropriate level based on MDM or Time. Medicare does not allow payment for inpatient consultation codes 99252-99255.

*This response is based on the best information available as of 3/27/25.