APRIL 2010

The “BELIEVE IT OR NOT” with Pain Management Coding

1. Epidural injections are only reported one time per date of service for a given region, it would not be appropriate to append modifier 50 for a bilateral procedure nor modifier 59 for multiple levels.
   
   
2. An epidural injection at T12-L1 is reported with the cervical epidural injection code, but a facet joint injection at T12-L1 is reported with a lumbar facet injection code.
   
   
3. A facet injection code is reported as one level when 2 medial branch nerves are injected but destruction codes are reported for two levels when 2 medial branch nerves are destroyed.
   
   
4. Facet injections that are performed without the use of fluoroscopy are reported with trigger point injection codes.
   
   
5. Facet joint injections performed using ultrasound are reported with Category III codes 0213T-0218T and as of July 1, 2010 Transforaminal injections using ultrasound will be reported with Category III codes 0228T-0231T.
   
   
6. An L3-L4 transforaminal injection is reported as one level, but injections into the L3, L4 foramen are reported as two levels.
   
   
7. Radiofrequency nerve ablation is reported with the appropriate CPT code, Pulsed Radiofrequency is reported with Unlisted CPT code 64999.
   
   
8. Destruction of lateral branch nerves S1-S4 using the Simplicity III probe is reported with Unlisted CPT one time for each nerve. code 64999, but when each lateral branch nerve is individually destroyed CPT code 64040 is reported.
   
   
9. SI joint injections that are performed without the use of fluoroscopy are reported with the large joint injection code 20610.
   
   
10. Sympathetic nerve blocks performed using fluoroscopy are reported with CPT code 77002 rather than 77003.