How to Bill for Selective Nerve Root Block Lumbar Left L4/L5

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Reader’s Question: from NC

Selective Nerve Root Block Lumbar Left L4/L5
Using fluoroscopic guidance oblique toward the left approximately 30 degrees until the neuroforamen was visualized L4/L5 just lateral to the superior articular process. The skin was anesthetized over this area with 1% lidocaine with ephinephrine. a 25 gauge spinal needle was then advanced to the 6:00 position under the pedicles at left L4. After negative aspiration, 1 cc of Omnipaque 240 dye was injected and dye spread can be seen moving evenly through the neural foramen the epidural space. A total of 1 cc bupivacaine 0.25% and 40 of kenalog was then injected through the neuroforamen and the needle was removed.

I am trying to figure out if I should bill CPT 64483 or 64450. Any help I can get is greatly appreciated. Thanks

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Thank you for your email. Your code should be 64483 – Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level. Append your Modifier LT for the left side.

You cannot use the CPT Code 64450; Injection, anesthetic agent; other peripheral nerve or branch because it is not a ”peripheral nerve or branch” based on this documentation.

Read more related content here https://www.mspinkymaniri.com/2018/04/billing-for-cpt-transforaminal-64483-64484-and-interlaminar-epidural-62323-together-unbundling/

Read more articles here on Pain Management Coding and Billing

https://www.mspinkymaniri.com/2017/01/2017-epidural-new-codes-for-pain-management-practice-its-in-the-imaging/

Here are your codes for Transforaminal Epidural

CPT Code 64479 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, single level CPT Code 64480 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional level (List separately in addition to code for primary procedure) CPT Code 64483 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level CPT Code 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)

And here are your Interminar or Caudal Epidural. Take note of the ones that include guidance

CPT Code 62321 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy or CT) CPT Code 62322 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance CPT Code 62323 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT) CPT Code 62324 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance CPT Code 62325 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy or CT) CPT Code 62326 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance CPT Code 62327 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT)
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