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Providing free resources and useful informations for Physicians,
Office Managers, Medical Billers and Medical Coders
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 NOVITAS
SOLUTIONS. Read more on the diagnostic and therapeutic medical
necessity of these codes. The medical documentation requirements is also
a must for you to know!

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Sources and References: AMA's CPT Assistant, NCCI Edits from CMS
Website, Highmark Medicare Services LCD, OIG Reports

CPT IS OWNED AND IS A REGISTERED TRADEMARK OF THE
AMERICAN MEDICAL ASSOCIATION.

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