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| Transforaminal Epidural Injection / Pain Management Code Services 64483, +64484, 64479, +64480 - Are you properly Billing for these Services? |
Effective January 01, 2011 - these codes have been REVISED
Please check this page on my website. CLICK HERE.
"Thirty-four percent (34%) of transforaminal epidural injection services allowed by
Medicare in 2007 did not meet Medicare requirements resulting in approximately $45
million in improper payments", according to OIG's review. Nineteen percent is due to lack
of documentation and 13 percent is due to non-medical necessity. Eight percent is due to
improper coding. Read more on this report from the OIG.
What you can do, educate yourself on proper coding for pain management services.
Transforaminal Epidural injection has the following codes:
Transforaminal Epidural Injection is an approach where the needle/ injection enters
the epidural space and nerve root through the intervertebral foramen.
64479 Injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or
thoracic, single level
64480 Injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or
thoracic, each additional level (List separately in addition to code for primary procedure)
64483 Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or
sacral, single level
64484 Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or
sacral, each additional level (List separately in addition to code for primary procedure)
Let’s try coding:
-> Transforaminal Injections at L4-L5-SI
Spinal Nerve L4 (interspace L4-L5 )
Spinal Nerve L5 (interspace L5-S1)
Spinal Nerve S1 (foramen)
Your Codes:
64483 - 1 unit
64484 – 2 units
-> Transforaminal Injections at C4 and C5 Spinal Nerves
Your Codes:
64479 (C3-C4 intervertebral foramen; C4 Spinal Nerve )
64480 (C4-C5 intervertebral foramen; C5 Spinal Nerve )
-> How do you BILL for BILATERAL (left and side) procedure? (very important to
know!)
You append modifier 50 (indicates bilateral) - check with your payors how they
recognize a bilateral procedure!
64479 – 50 1 unit (** not two units because of left and right side!)
64480 – 50 1 unit (** remember this is an add-on code!)
Your Fluorocoscopic/Needle Placement Guidance Code:
77003 (append modifier 26 if professional component, no modifier if done in the office
setting!)
Your Place of Service Codes: (very important to know!)
Office - 11
ASC (Ambulatory Surgery Center) - 24
OP (Outpatient Hospital) - 22
Your reimbursement for bilateral procedures is 150% based on the allowed amount.
Now, make sure you read and understand your payors' clinical policy and guidelines.
Timely, Proper and Accurate Documentation is the key! Make sure your physician
documents the encounter and establish medical necessity! Conduct internal audits on a
regular basis in your practice and check your coding and billing encounters.
Here is a copy of an LCD - LCD L27512 - Transforaminal Epidural, Paravertebral Facet
and Sacroiliac Joint Injections from Highmark Medicare Services. Read more on the
diagnostic and therapeutic medical necessity of these codes. The medical documentation
requirements is also a must for you to know!
Sources and References: AMA's CPT Assistant, NCCI Edits from CMS Website, Highmark
Medicare Services LCD, OIG Reports
CPT IS OWNED BY THE AMA.
Please check this page on my website. CLICK HERE.
"Thirty-four percent (34%) of transforaminal epidural injection services allowed by
Medicare in 2007 did not meet Medicare requirements resulting in approximately $45
million in improper payments", according to OIG's review. Nineteen percent is due to lack
of documentation and 13 percent is due to non-medical necessity. Eight percent is due to
improper coding. Read more on this report from the OIG.
What you can do, educate yourself on proper coding for pain management services.
Transforaminal Epidural injection has the following codes:
Transforaminal Epidural Injection is an approach where the needle/ injection enters
the epidural space and nerve root through the intervertebral foramen.
64479 Injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or
thoracic, single level
64480 Injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or
thoracic, each additional level (List separately in addition to code for primary procedure)
64483 Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or
sacral, single level
64484 Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or
sacral, each additional level (List separately in addition to code for primary procedure)
Let’s try coding:
-> Transforaminal Injections at L4-L5-SI
Spinal Nerve L4 (interspace L4-L5 )
Spinal Nerve L5 (interspace L5-S1)
Spinal Nerve S1 (foramen)
Your Codes:
64483 - 1 unit
64484 – 2 units
-> Transforaminal Injections at C4 and C5 Spinal Nerves
Your Codes:
64479 (C3-C4 intervertebral foramen; C4 Spinal Nerve )
64480 (C4-C5 intervertebral foramen; C5 Spinal Nerve )
-> How do you BILL for BILATERAL (left and side) procedure? (very important to
know!)
You append modifier 50 (indicates bilateral) - check with your payors how they
recognize a bilateral procedure!
64479 – 50 1 unit (** not two units because of left and right side!)
64480 – 50 1 unit (** remember this is an add-on code!)
Your Fluorocoscopic/Needle Placement Guidance Code:
77003 (append modifier 26 if professional component, no modifier if done in the office
setting!)
Your Place of Service Codes: (very important to know!)
Office - 11
ASC (Ambulatory Surgery Center) - 24
OP (Outpatient Hospital) - 22
Your reimbursement for bilateral procedures is 150% based on the allowed amount.
Now, make sure you read and understand your payors' clinical policy and guidelines.
Timely, Proper and Accurate Documentation is the key! Make sure your physician
documents the encounter and establish medical necessity! Conduct internal audits on a
regular basis in your practice and check your coding and billing encounters.
Here is a copy of an LCD - LCD L27512 - Transforaminal Epidural, Paravertebral Facet
and Sacroiliac Joint Injections from Highmark Medicare Services. Read more on the
diagnostic and therapeutic medical necessity of these codes. The medical documentation
requirements is also a must for you to know!
Sources and References: AMA's CPT Assistant, NCCI Edits from CMS Website, Highmark
Medicare Services LCD, OIG Reports
CPT IS OWNED BY THE AMA.
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