The Office of Inspector General (OIG) Work Plan for 2010 includes a closer look at Medicare payments for transforaminal epidural injections. The Work Plan specifically states, “We will review Medicare claims to determine the appropriateness of Medicare Part B payments for transforaminal epidural injections.”
Stay out of the OIG crosshairs by ensuring that your pain management specialist documents each procedure thoroughly. Follow these steps to count levels and assign the appropriate codes correctly.
1. Understand What ‘Transforaminal’ Means
Physicians often administer transforaminal epidurals laterally through the selected neuroforamen under fluoroscopy, says Joanne Mehmert, CPC, CCS-P, president of Joanne Mehmert and Associates in Kansas City, Mo. Once there, the physician performs an injection at the nerve root area to help relieve the patient’s pain. The medication goes into the anterior epidural space, “bathing” a specific spinal nerve as it exits the spinal cord.
CPT includes four codes to represent transforaminal epidural injections, which you choose between based on the injection site and number of injections:
- 64479 — Injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, single level (2009 national average Medicare reimbursement of $114.69 facility/ $253.55 non-facility)
- +64480 — … cervical or thoracic, each additional level (List separately in addition to code for primary procedure) ($75.02 facility/$127.68 non-facility)
- 64483 — … lumbar or sacral, single level ($100.99 facility/$246.70 non-facility)
- +64484 — … lumbar or sacral, each additional level (List separately in addition to code for primary procedure) ($63.84 facility/$125.15 non-facility).
Procedure note: Although you report the same codes, a transforaminal injection is different from a selective nerve root block (SNRB). With SNRB, your provider injects right beside the nerve root where the nerve exits the foramen. The injection occurs outside the spine, which differs from a transforaminal. Coders sometimes interchange...
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