Providing free resources and useful informations for Physicians,
Office Managers, Medical Billers and Medical Coders
Pain Management
Have you Read Some of My Useful Articles?

I have been a Pain Management Coder for nearly 10 years now. And I
Key pointers that you need to remember when coding for Pain
Management Services are:

Most of the Pain Management Coding for spinal injection procedures are
UNILATERAL procedures. Therefore, these codes are reported once per
level, per region or per site regardless of the number or type of injection
performed per level, per region and per side.

It is inappropriate to report injection on the spine procedures for each
injection performed at a particular level and side.

If both sides of the same joint level/site/side are injected, then modifier
–50  must be appended to the specific injection procedure code to
indicate that bilateral procedures were performed.

Here's a useful tip: Report only 1 unit when performed on the same level -
because the modifier 50 is already indicating 2 sides (a left and a right).

For example a bilateral 64490 should be billed as 64490 with modifier -50  
for 1 unit.

Fluoroscopic Guidance - most of the Fluoro are now being bundled with
the CPT codes. So be careful with not billing for CPT Code 77003. Read
the description of the CPT code procedure first.

    Here are Your Pain Management Procedures
Transforaminal Epidural Injections
Interlaminar / Caudal Epidural Injections
Facet Joint Nerve Block
Facet Joint Nerve Destruction
Sacroiliac Injections
Musculoskeletal Injections
Somatic Nerve Blocks
Sympathetic Nerve Blocks
IDET / Nucleoplasty
Pump Implants
Spinal Stimulator Implants

Let's look at this honest mistake that my one of my readers sent me an email:

The email said:
"we have been getting denials for CPT code 64484 for
additional levels as - "the code do not support medical documentation"

And this was my reply to that email:

"Well, let's look at what the pain doc actually performed"

64483 Injection(s), anesthetic agent and/or steroid, transforaminal
epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral,
single level

64484 Injection(s), anesthetic agent and/or steroid, transforaminal
epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral,
each additional level (List separately in addition to code
for primary procedure)

Now, read your Physician's documentation, is it really an add-on level? or
maybe it is a bilateral procedure (left and right side) or unilateral;

If it is bilateral, then you do not need the 64484 - remember this code is
only be used for each additional level (not for the other "anatomical side" -
left or right!). If it is bilateral, you
need to use the modifier 50.

Modifier 51 for 64484 is NOT allowed.

Here are some of my previous Articles on Pain
Management Coding:

Billing and Coding for your Joint SacroIliac Injection

Billing and Coding for Paravertebral Facet Nerve Block

The Chemodenervation Codes 64613 and 64614 is now BILLABLE again
as BILATERAL Effective January 01, 2012  

Trigger Point Injections Coding and Billing - Pain Management Are you
Properly Coding and Billing for your Services?

How to properly code the radio frequency ablation when performed on
L5,  S1, S2 and S3 nerves. This confusion has come to an end.

Transforaminal Epidural Injection / Pain Management Code Services Are
you properly Billing for these Services?

The Question is:   What if the Transforaminal Epidural  Injection was
performed without Imaging Guidance or CT Scan? How  do you bill and
code for this service? (see what the AMA has a comment on this)

What is the right code and how would you bill for a Sacrococcygeal
Injection? Is it correct to consider 64493?

Referencences:  CPT Changes 2012, CPT Code Book 2012.

**** For more references: Consult your CPT code books. The National
Correct Coding Initiative (NCCI) and third pary payer payment policies and

Disclaimer:  CPT is owned, mantained and is a registered
trademark of the American Medical Association