Pain Management CPT Coding

Pain Management CPT Coding

Joints and Bursa – Injection or Aspiration

• Major joint/bursa: 20610 (knee, hip, shoulder, trochanteric bursa, subacromial bursa, pes anserine bursa)
• Intermediate joint/bursa: 20605 (temporomandibular, acromioclavicular, wrist, elbow, ankle, olecranon bursa)
• Minor joint/bursa: 20600 (fingers [PIP, DIP], toes)
• Sacroiliac joint (SIJ) with fluoroscopy: 27096
• Sacroiliac joint (SIJ) without fluoroscopy: 20552 (billed as a trigger point injection)
• Fluoroscopic needle guidance (non-spinal): 77002

Tendons, Ligaments, and Muscle Injections

• Tendon sheath or Ligament: 20550 (iliolumbar ligament, trigger finger, De Quervain’s tenosynovitis, plantar fascia)
• Tendon origin/insertion: 20551
• Trigger point injection (1 or 2 muscles): 20552
• Trigger point injection (3 or more muscles): 20553
• Sacroiliac joint (SIJ) without fluoroscopy: 20552 (billed as a trigger point injection)
• Intramuscular injections: 96372
• Fluoroscopic needle guidance (non-spinal): 77002

Nerve Blocks

• Greater occipital nerve block: 64405
• Lesser occipital nerve block: 64450
• Other peripheral nerve: 64450 (I use this for third occipital nerve blocks [TON block] and superior cluneal nerve blocks)
• Other peripheral nerve: 64640 (used for S1, S2, S3 lateral branches during RFA)
• Suprascapular nerve: 64418
• Intercostal nerve (single): 64420
• Intercostal nerve (multiple): 64421
• Ilioinguinal and Iliohypogastric nerve: 64425
• Trigeminal nerve (any branch): 64400
• Sphenopalatine ganglion: 64505
• Stellate ganglion (cervical sympathetic): 64510
• Superior hypogastric plexus: 64517
• Thoracic or lumbar paravertebral sympathetic: 64520
• Celiac plexus: 64530
• Plantar common digital nerve (Morton’s neuroma): 64455
• Unlisted procedure: 64999

Epidural Steroid Injections (ESI)

• Interlaminar
• Interlaminar – cervical or thoracic: 62310
• Interlaminar – lumbar or sacral: 62311
• Fluoroscopic needle guidance (Spinal): 77003
• Transforaminal
• Transforaminal – cervical or thoracic (first level): 64479
• Transforaminal – cervical or thoracic (each additional level): 64480
• Transforaminal – lumbar or sacral (first level): 64483
• Transforaminal – lumbar or sacral (each additional level): 64484
• Remember: Fluoro can NOT be billed separately for these.
• Ex: A bilateral L5 TF ESI would be billed as 64483 -50.

Facet Joint Procedures

• Intraarticular Joint or Medial Branch Block
• Intraarticular joint or medial branch block (MBB) – cervical or thoracic (1st level or site): 64490
• Intraarticular joint or medial branch block (MBB) – cervical or thoracic (2nd level or site): 64491
• Intraarticular joint or medial branch block (MBB) – cervical or thoracic (3rd level or site): 64492
• Intraarticular joint or medial branch block (MBB) – lumbar or sacral (1st level or site): 64493
• Intraarticular joint or medial branch block (MBB) – lumbar or sacral (2nd level or site): 64494
• Intraarticular joint or medial branch block (MBB) – lumbar or sacral (3rd level or site): 64495
• Note: You can bill for bilateral facets or MBB at the same levels (with the -50 modifier), but you will NOT typically get reimbursed for over 3 facet joints or medial branches on the same side.
• Ex: Bilateral L3, L4, L5 MBBs would be billed as 64493 -50, 64494 -50, and 64495 -50.
• Note: Many use 64450 (other peripheral nerve) for third occipital nerve (TON) blocks.
• Remember: Fluoro can NOT be billed separately for these.

• Radiofrequency Ablation (RFA) / “Destruction” of Facet Joint
• Radiofrequency ablation (RFA) – cervical or thoracic (1st joint): 64633
• Radiofrequency ablation (RFA) – cervical or thoracic (each additional joint): 64634
• Radiofrequency ablation (RFA) – lumbar or sacral (1st joint): 64635
• Radiofrequency ablation (RFA) – lumbar or sacral (each additional joint): 64636
• Remember: Fluoro can NOT be billed separately for these.

Sacroiliac Joint

• Sacroiliac joint (SIJ) without fluoroscopy: 20552 (billed as a trigger point injection)
• Sacroiliac joint (SIJ) with fluoroscopy: 27096
• Sacral lateral branch blocks: 64450
• Radiofrequency Ablation (RFA) of the Sacroiliac Joint
• RF of L5 dorsal primary ramus: 64635
• RF of S1 lateral branches: 64640
• RF of S2 lateral branches: 64640
• RF of S3 lateral branches: 64640
• Fluoroscopic needle guidance (Spinal): 77003 (for the S1-S3 nerve lateral branches, not the L5)
• Note: Use 724.6 (Disorder of the sacrum) and 721.3 (lumbar spondylosis) as the diagnostic codes

Vertebroplasty / Kyphoplasty

• Vertebroplasty
• Vertebroplasty – Thoracic (1st level): 22520
• Vertebroplasty – Thoracic (each additional level): 22522
• Vertebroplasty – Lumbar (1st level): 22521
• Vertebroplasty – Lumbar (each additional level): 22522
• Note: Same charge whether you perform unilateral or bilateral injection of cement (PMMA).

• Kyphoplasty
• Kyphoplasty – Thoracic (1st level): 22523
• Kyphoplasty – Thoracic (each additional level): 22525
• Kyphoplasty – Lumbar (1st level): 22524
• Kyphoplasty – Lumbar (each additional level): 22525
• Fluoroscopic guidance (radiologic supervision & interpretation) for vertebroplasty or kyphoplasty: 72291
• Under CT guidance: 72292

Neurostimulation (Spinal Cord Stimulator / Dorsal Column Stimulator)

• Trial Procedure
• Percutaneous implant of electrode array: 63650 (includes 10-day global) – bill two units if you implant two trial leads
• Implantation of Spinal Cord Stimulator Percutaneous Leads and Generator
• Percutaneous implant of electrode array: 63650 (includes 10-day global)
• Insertion or replacement of pulse generator: 63685 (includes 10-day global)
• Implantation of Spinal Cord Stimulator PADDLE Leads and Generator
• Laminectomy for implant of neurostimulator electrode, paddle: 63655 (includes 90-day global)
• Insertion or replacement of pulse generator: 63685 (includes 10-day global)
• Removal of Leads/Generator (Explant)
• Removal of spinal neurostimulator percutaneous array(s): 63661 (includes 10-day global)
• Removal of spinal neurostimulator paddle electrode: 63662 (includes 90-day global)
• Removal of pulse generator: 63688 (includes 10-day global)
• Important: Also bill for the implanted neurostimulator electrodes (each lead): L8680

Discogram / Discography

• Discogram / Discography – Cervical/Thoracic (each disc): 62291
• Supervision & interpretation of fluoroscopy – Cervical/Thoracic (each disc): 72285
• Discogram / Discography – Lumbar (each disc): 62290
• Supervision & interpretation of fluoroscopy – Lumbar (each disc): 72295
• Remember: Fluoroscopy is bundled here and can NOT be billed separately for these.

Botulinum Toxin Injections

• Botulinum toxin type A – Botox, Dysport (per unit): J0585
• Botulinum toxin type B – Myobloc (per 100 units): J0587
• Needle electromyography in conjunction with chemodenervation: 95874
• Chemodenervation of muscles in the neck (spasmodic torticollis): 64613
• Chemodenervation of muscles of the trunk and/or extremity (cerebral palsy, dystonia, multiple sclerosis): 64614
• Chemodenervation of muscles innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (chronic migraine): 64615

Other

• Carpal tunnel injection: 20526
• Epidural blood patch: 62273
• Moderate sedation (first 30 minutes): 99144 (requires presence of another trained person to monitor the patient’s consciousness and vitals)
• Moderate sedation (each additional 15 minutes): 99145
• Fluoroscopic needle guidance (spinal): 77003
• Fluoroscopic needle guidance (non-spinal): 77002
• CT needle guidance: 77012

Modifiers

• -50: Bilateral
• -52: Incomplete procedure (reduced service) [I have used this for hip or epidural injections that the patient didn't tolerate and so it wasn't completed]
• -26: Professional component only

Injectables (J-codes)

• Omnipaque 300 (per ml): Q9967
• Dexamethasone sodium phosphate (per mg): J1100
• Celestone (per 3 mg): J0702
• Celestone (per 4 mg): J0704
• Depo-Medrol (40mg): J1030
• Depo-Medrol (80mg): J1040
• Kenalog/Triamcinolone (per 10 mg): J3301
• Toradol/Ketorolac (per 15mg): J1885 (don’t forget the 96372 code if injected intramuscular)
• Methocarbamol – Robaxin (up to 10 ml): J2800 (don’t forget the 96372 code if injected intramuscular)
• Synvisc 3 dose (per 2 ml syringe): J7325
• Synvisc One (per 6 ml syringe): J7325S
• Versed (per mg): J2250
• Fentanyl (0.1 mg): J3010
• Diphenhydramine – Benadryl (injection up to 50-mg): J1200
• Botulinum toxin type A – Botox, Dysport (per unit): J0585
• Botulinum toxin type B – Myobloc (per 100 units): J0587

Electromyography (EMG) & Nerve Conduction Studies (NCS)

• Sensory NCS (each nerve): 95904
• Motor NCS w/o F-wave (each): 95900
• Motor NCS with F-wave (each): 95903
• H-reflex (gastrocnemius/soleus): 95934
• H-reflex (other than gastroc/soleus): 95936
• Blink reflex (orbicularis oculi): 95933 (only once per study)
• EMG guidance during botulinum toxin injections: 95874
• Add modifier -26 if you don’t own the EMG machine you’re using
• EMG w/NCS, each extremity, “limited” (4 or fewer muscles): 95885
• EMG w/NCS, each extremity, “complete” (5+ muscles, innervated by 3+ nerves or 4+ spinal levels): 95886
• EMG w/o NCS on same day: one extremity = 95860, two extremities = 95861, three = 95863, four = 95864
• Cranial nerves
• EMG (unilateral): 95867
• EMG (bilateral ): 95868
• Note: EMG needles can not be billed separately, as they are included in the EMG codes
• Muscle testing before the study
• Extremity w/o hand (must include a report of this): 95831
• Hand: 95832

 

• 2013 CPT Coding Changes for Nerve Conduction Studies – Effective January 1, 2013
• Each conduction study is counted as one for sensory, motor with or without F-wave, or H-reflex. Orthodromic and antidromic tests on the same nerve count only once.
• Example: Bilateral sensory and motor median and ulnar NCS is performed. This is eight (8) separate tests, so the proper code now is 95910. Adding a radial sensory on one side would then make it a 95911.
• 1-2 NCS = 95907
• 3-4 NCS = 95908
• 5-6 NCS = 95909
• 7-8 NCS = 95910
• 9-10 NCS = 95911
• 11-12 NCS = 95912
• 13+ NCS = 95913

Source: http://thepainsource.com/