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Painful Spinal Hardware
Our physician injected 0.5% Marcaine and 80 mg of Depo-Medrol to existing spinal hardware (eg, pedicle screws) at L4, L5, and S1 bilaterally for a patient complaining of painful hardware. Can CPT code 64483 be reported?
Question:
Our physician injected 0.5% Marcaine and 80 mg of Depo-Medrol to existing spinal hardware (eg, pedicle screws) at L4, L5, and S1 bilaterally for a patient complaining of painful hardware. Can CPT code 64483 be reported?
Answer:
No. CPT code 64483, (Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level), represents transforaminal epidural nerve root injection performed in the lumbar region. There is no specific CPT code for the injection of spinal hardware. CPT code 64999, Unlisted procedure, nervous system, would be most appropriate to describe the injections for pain performed outside the foramen, as indicated in the clinical scenario provided in this inquiry. Although three spinal level (L4, L5, S1 bilaterally) injections were performed, code 64999 should be reported only once to represent the multiple injections.
*This response is based on the best information available as of 5/9/24.
Ganglion Impar Injection
What is the correct code to report when our physician performs a ganglion impar injection with Depo-Medrol and Lidocaine?
Question:
What is the correct code to report when our physician performs a ganglion impar injection with Depo-Medrol and Lidocaine?
Answer:
The most appropriate code for this procedure is unlisted. However, as with all pain injections, check your payor policies regarding specific coverage.
*This response is based on the best information available as of 4/25/24.
Genicular Nerve Injection
What is the correct code to report when our physician performs a ganglion impar injection with Depo-Medrol and Lidocaine?
Question:
What is the correct code (s) to report when the physician injects the superomedial and superolateral branches of the genicular nerve for knee pain with a steroid?
Answer:
The correct code to report for this service is 64454 (Injection (s), anesthetic agent (s) and/or steroid; genicular nerve branches including imaging guidance, when performed) with modifier 52 (Reduced Services). If all 3 nerve branches of the genicular nerve (superolateral, superomedial, and inferomedial) are not injected the service is reported with modifier 52. CPT code 64454 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 4/11/24.
Piriformis Muscle Injection
We perform Piriformis muscle injections in the office under ultrasound guidance, what code should we be reporting for this service?
Question:
We perform Piriformis muscle injections in the office under ultrasound guidance, what code should we be reporting for this service?
Answer:
The correct code(s) that should be reported for the service are 20552 for the piriformis muscle injection and 76942 for the ultrasound guidance.
Rationale: 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 3/28/24.
Sphenopalatine Ganglion Block
How do I report a ganglion impar injection of Depo-Medrol and Lidocaine?
Question:
How do I report a ganglion impar injection of Depo-Medrol and Lidocaine?
Answer:
The most appropriate code for this procedure is unlisted. However, as with all pain injections, check your payor policies. Some policies consider a ganglion impar injection, specifically for rectal or pelvic pain, as not medically necessary. Others allow payment with an unlisted code. Using an existing code such as 64450, other peripheral nerve, without knowing the payor’s policy may get reimbursed inappropriately.
*This response is based on the best information available as of 3/14/24.
New to Pain Management
Pain Management is a brand-new service line for our practice, we have 20 Orthopaedic surgeons (one is interventional ortho/pain management). We just purchased a C-Arm and are using it in the office. The pain management surgeon was using this at the outpatient surgical facility. Is there anything specific regarding billing for the C-Arm for place of service 11 (office) that we should be aware of?
Question:
Pain Management is a brand-new service line for our practice, we have 20 Orthopaedic surgeons (one is interventional ortho/pain management). We just purchased a C-Arm and are using it in the office. The pain management surgeon was using this at the outpatient surgical facility. Is there anything specific regarding billing for the C-Arm for place of service 11 (office) that we should be aware of?
Answer:
KZA recommends that you reach out directly to the specific insurance carriers that you are contracted with regarding coverage and reimbursement of the C-Arm. Most pain management procedures include the use of C-Arm in the performance of the procedure and therefore, the use of the C-Arm would not be reported in addition. KZA also recommends you check your Medicare Administrative Contractor (MAC) for specific Local Coverage Determinations (LCDs) for any pain management procedures your clinic will be performing. The LCDs provide information regarding the coverage criteria, requirements, and medical necessity for the procedure(s).
*This response is based on the best information available as of 2/29/24.