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Coding for Transforaminal Epidural, Paravertebral Facet Joint,
Epidurals and SI Injection with Ultrasound. Can we separately bill
for the Ultrasound?
One of my clients ask me this question:

Hi, Ms. Pinky, this is regarding coding for Transforaminal Epidural, Paravertebral Facet
Joint, Epidurals and SI Injection with Ultrasound. Can we separately bill for the Ultrasound?

My reply:

Let's look at each of this procedure:

For Transforaminal Epidural:
You must use the category 3 codes for your Transforaminal Epidural Injection (DO NOT
USE 64479, +64480, 64483, +64484)!

0228T     Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with
ultrasound guidance, cervical or thoracic; single level    

0229T     Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with
ultrasound guidance, cervical or thoracic; each additional level

0230T     Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with
ultrasound guidance, lumbar or sacral; single level    


0231T     Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with
ultrasound guidance, lumbar or sacral; each additional level (List separately in addition to
code for primary procedure)

Hence, the ultrasound guidance with the TFEs or Transforaminal epidural injection CAN
NOT be billed separately! Because the appropriate code from the category III is already
"with ultrasound guidance".

Now, let's take a look at the ultrasound code:

767942 - Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection,
localization device), imaging supervision and interpretation

And looking at our procedure code book 2012; it specifically states there:
("Do not report 76942 in conjunction with 27096, 64479-64484, 64490-64495,
0228T-0231T, 0232T, or 0249T")


That means, your ultrasound code 76942 is not billable with your:

Transforaminal Epidural Codes (644790-64484)
Paravertebral Facet Joint Codes (64490-64495)
SI Injection (27096)
Category 3 Codes for the Transforaminal Epidural with ultrasound (0228T-0231T, 0232T,
or 0249T)

However, Ultrasound Guidance code 76942 can be separately billable with your ESI

62310 (cervical or thoracic )
62311 (lumbar or sacral (caudal)

I hope this helps.

Always refer to your code books and your payors' guidelines especially with your
Medicare Local Carrier!
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