This page addresses follow-up questions and additional information pertinent to our webinar
Pain Management - Part 1: Injections.
** 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:  I just watched Pain Management-Part 1 Injections. I am still unclear as to how to how to charge Bilateral Lumbar RFA Ablation for 3 levels. Procedure: (from a chart) Lumbar Medial Branch Nerve Radiofrequency Ablation Bilateral Side(s) at the L4, L5, and sacral ala Levels with Fluoroscopic Guidance. For the first level, I use 64635-50. How do you charge the other 2 levels?
A:  Since the injection code specifies injection of the facet joint, this is injection of two joints (L4-5 and L5-S1), not three. This code is assigned based on the joints between levels rather than the levels themselves. The first joint is reported with code 64635-50 and the second joint is reported with 64636-RT and 64636-LT. For bilateral procedures, the CPT book gives instruction to report 64635 with modifier 50 and code 64636 twice. CPT guidelines also state that modifier 50 is not to be used with add-on codes and that procedures reported with add-on codes should be reported twice when performed bilaterally.

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Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer

Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer

Director of Coding Quality & Education

Kristi is the Director of Coding Quality & Education with more than 25 years of industry experience; she is responsible for the development of web-based, instructor-led, and webinar training materials; conducting training in ICD-10-CM/PCS and CPT; and performing DRG and APC audits. Kristi has an extensive background in coding education and consulting and is a national speaker and published writer on topics related to ICD-10 and CPT coding and code-based reimbursement. She has designed and developed training programs for inpatient and outpatient hospital-based coding, with a focus on vascular interventional radiology, interventional cardiology, orthopedics, and obstetrics.


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