Procedure Practice 01/15/99 - Feature Article 01/15/99
   

Procedure Practice 01/15/99:
Coding Recommendations

  
Listed below are the ICD-9-CM diagnosis and procedure codes as well as the CPT-4 procedure codes that we think properly classify the treatment described. Please note that modifiers, used only for physician billing purposes, have not been assigned to the CPT-4 codes. If you disagree with our suggestions or have other comments, please send an e-mail to codingedge@lagunamedsys.com.
   

Report 1 - Suggested Codes and Rationale
   

Diagnosis Codes

The patient had lumbar radiculopathy due to herniated lumbar intervertebral disks. In the Alphabetic Index under "Radiculopathy," we are referred to radiculitis. Under "Radiculitis," we find a subentry for "Radiculitis due to displacement of intervertebral disk: see Neuritis due to displacement of intervertebral disk." Reviewing the selections under this entry, we find that neuritis due to a herniated lumbar disk is coded 722.10. The Tabular List confirms that this is the correct diagnosis code: Displacement of lumbar intervertebral disk without myelopathy.
  

ICD-9-CM Procedure Codes

The physician injected the epidural space with a mixture of steroid medication and local anesthetic. Under the Alphabetic Listing for "Injection, spinal, steroid," we find 03.92, the correct code for this procedure.
  

CPT-4 Procedure Codes

When assigning CPT codes for spinal injections, it is important to know why the injection was needed and the main substance injected. The patient's history indicated that two prior epidural injections had been administered for long-term (two and a half months) pain relief. We know that local anesthetic injections are for quick, short-term pain relief. So even though some anesthetic medication was in the solution, the steroid was the primary therapeutic substance administered in this case. Code the epidural steroid injection 62289, Injection of substance other than anesthetic, antispasmodic, contrast, or neurolytic solutions, lumbar or caudal epidural (separate procedure).
  

Report 2 - Suggested Codes and Rationale
   

Diagnosis Codes

In the Alphabetic Index under "Neuralgia, trigeminal," we are directed to code 350.1. The Tabular List confirms that 350.1 is the correct code: Trigeminal neuralgia, tic douloureux, trifacial neuralgia, trigemininal neuralgia NOS.
  

ICD-9-CM Procedure Code

The surgeon performed a peripheral nerve block injection on the peripheral maxillary nerve. In the Alphabetic Index see "Injection, nerve (cranial) (peripheral); anesthetic for analgesia," which directs us to code 04.81. Turning to 04.81 in the Tabular List, we find that this is the correct code for this procedure: Injection of anesthetic into peripheral nerve for analgesia.
  

CPT-4 Procedure Codes

In the CPT Index under "Nerves, injection, anesthetic," we find the range of codes 64400-64530. A review of these codes shows that 64402 best describes the injection of anesthetic into a facial nerve: Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic; somatic nerves; facial nerve.

Procedure Practice 01/15/99 - Feature Article 01/15/99