This page addresses follow-up questions and additional information pertinent to our webinar
Pain Points: Coding for Pain Management.
** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.
Q: When doing a TFESI for T12/L1 we are to use 64479 per CPT instructions. What if a second level is done L1/L2? What add-on code should we use? Does the add-on code need to be from same region as the primary code?
A: Per CPT instructions, use +64484 if the second level is in the lumbar or sacral region.
A: The instruction to report code 64999, Unlisted procedure, nervous system, for “low grade thermal energy (<80 degrees Celsius)” applies only to codes 64633-64636 because the instructional parenthetical note before code 64633, Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint, lists these codes specifically. Reference: CPT Assistant December 2020
Q: What if I have two limbs with different numbers of muscles? For example: one arm had 2 muscles denervated and the other arm had 5 muscles. Is there a rule about which base code I use? 64642 or 64644?
A: Use the limb with the most number of injection first as the base. Followed by the rest of the limbs with the appropriate add-on code based on the number of muscles. For this scenario use 64644, 64643.
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Emily Lomaquahu, CPC, CPMA, CEDC
Senior Coding Quality Auditor & Educator
Emily is a Senior Coding Quality Auditor for Haugen Consulting Group and brings over a decade of experience to the profee team! She began her career as an auditor and with her keen eye for detail, she quickly found it was a perfect fit. Emily thrives in a collaborative environment and enjoys creating high-quality trainings to help providers and coders navigate charts and improve their accuracy. She earned a bachelor’s degree from the University of Colorado, in Denver. Emily specializes in Evaluation and Management (E/M), Primary Care, Anesthesia, Emergency Department, and Neurology, though she says Anesthesia and Neurology are her favorites! She is a Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), and Certified Emergency Department Coder (CEDC).