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Part 2: Strengthen your ICD-10-PCS coding for lumbar spinal fusion procedures. Coding spinal fusion in an outpatient or ambulatory surgery center (ASC) setting with CPT® is very different than coding spinal fusion in the inpatient setting with ICD-10-PCS. For example, as illustrated in Figure 1, CPT® divides the spine into three columns: Anterior (anterior two-thirds […]
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If a facet nerve block (64490-64495) or ablation spans two spinal regions, since the description in the additional level CPT codes indicate the regions (ie 64491-64492 indicate cervical or thoracic and 64494-64495 indicate lumbar or sacral), does that mean, you would jump to the primary code of the next spinal region for the additional levels?
For example, T11-L2 facet nerve block. Would it be 64490 for T11-12, 64491 for T12-L1, & 64493 for L1-2 or should the L1-2 be coded as 64492?
The only guideline I can find is in the NCCI where it talks about procedures done at contiguous spine levels but it mentions if the additional level code doesnt indicate the spine region that you would use the add on code rather than another primary code.
Thanks!
Any thoughts would be appreciated.
Sheila, CPC
Procedure: Left sided L3-L4, and L4-L5 invasive tubular discectomy.
Patient placed prone on a Wilson frame, arms were protected, all bony prominences were carefully padded, low back was prepped and draped in usual sterile fashion, a needle was placed in the L3-L4 disc space from approximately 45 degrees oblique, a discogram was done using Isovue and Isogreen and showed a clear tear in the L3-L4 disc with extensive dye spread, next, a percutaneous small incision was made over the needle, A guidewire was placed in the L3-L4 disc space and dilating tube was placed into guidewire was placed in the L3-L4 disc space and dilating tube was placed into the L3-L4 disc space. Next pituitary rongeur was used to create a far lateral discectomy at L3-L4, Multiple fragments of disc material were removed. An electrocautery was used to cauterize the annulus and the disc. A 40mg of Depo Medrol as well as Marcaine were injected into the disc and the dilating tube was removed. Next the exact same procedure was done at L4-L5 via separate incision. Wounds were copiously irrigated. Both the two wounds were closed using a nylon suture.
Thanks so much!
I need some help with a Pain Management procedure. What key words do I need to look for in a procedure note to differentiate between a Lumbar Interlaminar ESI Injection (CPT 62323) and a Lumbar Transforaminal ESI Injection (CPT 64483) so it can be coded accurately?
Below is the providers procedure note for review:
Procedure: Lumbar Epidural Steroid Injection under fluoroscopy.
Diagnosis: Lumbar Degenerative Disc Disease
The patient was evaluated and the procedure risks, benefits and alternatives were discussed with the patient. Informed consent was then obtained.
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The patient was taken into the procedure room and was placed prone on the table. Skin was prepped with chloraprep and draped in a sterile manner. Sterile technique was observed throughout the procedure. Fluoroscopy was used to identify the targeted L4-5 L5-S1 interspace. Using a 25 gauge needle 5cc of 1% lidocaine was used to achieve adequate local anesthesia.
A 20 gauge epidural needle was advanced into the epidural space under fluoroscopic guidance utilizing the loss or resistance technique[/COLOR][/COLOR]. No parasthesias were noted. After negative aspiration 1 ml of 300 omnipaque was injected. Contrast was confirmed in the epidural space via fluoroscopy. Methylprednisolone [ ] mg mixed with [ ] ml normal saline was slowly injected. The needle was removed intact. The patient remained awake and communicative throughout the procedure with no complaints of pain on injection.
The patient received 50-60% relief from this procedure.
The patient tolerated the procedure well and was transferred to the recovery area without complication and was discharged home after remaining stable during observation.
Appreciate your help.
Thank you.
Lauren