formed bilaterally on either side of the midline, so you'd bill in a bilat-
eral manner by appending either the -RT/-LT or the -50 modifier.
Imaging (fluoroscopy, computed tomography) is considered part of
the procedure here as well, so you can't bill separately for fluoroscopy
with code 77003-TC.
Use different codes for each additional level: Use code 64479 for a
cervical or thoracic single-level injection and 64480 as an add-on code
for each additional level. Medicare won't reimburse for add-on codes,
but many commercial payers will.
What if you perform both a translaminar and a transforaminal
injection on the same patient? These codes are not billable together
when they're performed at the same spinal area because they are
unbundled in the Medicare CCI edits. They'd have to be done at dif-
ferent spinal levels to be payable. For example, if you do the epidur-
al (62311) at level L5 and the transforaminal epidural (64483) at area
L4-5, the procedures are unbundled and not both billable. Only code
62311 would be billable in that case.
However, if the physician does an ESI (62311) at level L5 and a trans-
foraminal ESI (64483) at area L3-4, you can bill both codes, so long as
you put the -59 modifier on the 64483 code and bill it as the second
code following the 62311 ESI code on the claim form. The same
bundling rule applies to CPT 64483 and +64484 (lumbar and sacral
injections). You won't be paid beyond the first level injection by
Medicare.
Transforaminal ESI injections with ultrasound guidance
Medicare covers Category III CPT procedures for a TESI with ultra-
sound.
• 0228T. Single level cervical or thoracic injections.
• 0229T. Each additional level cervical or thoracic injection (list
N O V E M B E R 2 0 1 6 • O U T PA T I E N TS U R G E R Y. N E T • 3 7
