Billing and Coding Guidance for the Minuteman® Device in 2025
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1. What is the Minuteman® Procedure?
The Minuteman® G5 is a minimally invasive spinal fusion device provided by Spinal Simplicity, LLC. It’s specifically used to stabilize and fuse segments of the lumbar spine (T1 to S1), addressing conditions such as spinal stenosis, degenerative disc disease, and spondylolisthesis.

Unlike traditional spinal fusion surgeries, which often require larger incisions and extensive tissue disruption, the Minuteman® procedure employs a minimally invasive lateral or posterior approach. By doing so, it reduces the surgical footprint, preserving critical ligamentous structures and musculature, ultimately facilitating quicker patient recovery and reducing postoperative complications.

2. Appropriate CPT Codes for Billing
Billing accurately requires identifying appropriate CPT codes. According to the Spinal Simplicity 2025 billing guidelines, the following codes apply specifically to the Minuteman® implantation:

Key CPT Codes:

CPT CodeProcedure Description
22612
Posterior or posterolateral arthrodesis (fusion), single interspace; lumbar (with lateral transverse technique when performed).

22840
Posterior non-segmental instrumentation (attachment of fixation devices, e.g., rods or plates).
20930
Allograft placement or osteopromotive material for spinal surgery (This code is typically bundled and not reimbursed separately).

Explanation of the Codes:

• CPT 22612 (Arthrodesis, Lumbar):
  This CPT code is used when performing a posterior lumbar fusion at a single intervertebral space. It involves stabilizing and fusing two adjacent vertebrae to treat conditions like spinal stenosis or spondylolisthesis.
  Medicare Physician Fee Schedule (2025):
  • Work RVU: 47.79
  • Medicare Reimbursement: $1,553.60
• 22840 (Posterior Non-segmental Instrumentation):
  This code covers non-segmental fixation techniques such as placement of devices like the Minuteman®, where instrumentation attaches to adjacent spinal segments but does not extend across multiple levels. This CPT is billed separately from the arthrodesis code.
  Medicare Physician Fee Schedule (2025): Included separately with an additional reimbursement of approximately $400–$800 depending on payer-specific rules.
• 20930 (20931):
  These codes relate to the use of allograft materials (bone grafts), typically bundled into the primary fusion procedure and not reimbursed separately by Medicare.

3. Medical Necessity Documentation for the Minuteman® Device
For proper reimbursement, payers, including Medicare, require comprehensive documentation to justify medical necessity:

• Patient History & Symptoms:
  Clearly document persistent back pain, radiculopathy, neurological symptoms, functional impairment, and reduced quality of life despite conservative therapy.
• Imaging Studies:
  Include MRI, CT, or X-ray reports confirming conditions such as spinal stenosis, spondylolisthesis, degenerative disc disease, or segmental instability.
• Failed Conservative Therapy:
  Detail conservative management previously attempted—such as physical therapy, pharmacotherapy, chiropractic care, injections, or lifestyle modifications—that did not provide sustained improvement.
• Clinical Indications:
  Clearly state why the Minuteman® procedure is medically necessary, emphasizing failed conservative management, confirmed instability, or ongoing neurological compromise.

4. Clinical Guidelines and Insurance Utilization Policies
Insurance guidelines and utilization policies can vary significantly. Here's a detailed breakdown:
Medicare (CMS):

• CMS typically does not publish specific national coverage decisions for individual branded devices like the Minuteman®. Instead, Medicare coverage is determined at the local level by individual Medicare Administrative Contractors (MACs) through Local Coverage Determinations (LCDs).
• Coverage generally requires documented evidence of instability, neurological compromise, or progressive degenerative changes unresponsive to conservative treatment.
• Unlisted CPT code (22899) requires detailed narrative and supporting documentation to justify medical necessity.

Relevant LCD Example:

Novitas Solutions Local Coverage Determination (LCD): Lumbar Spinal Fusion (L35094).
URL: https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=35094 


Commercial Insurers (UnitedHealthcare, Anthem BCBS, Aetna, Cigna):

• UnitedHealthcare considers interspinous fusion devices, including Minuteman®, as investigational or experimental for certain conditions. Prior authorization is critical, with clear clinical justifications, detailed imaging, and previous treatment documentation.
• Anthem BCBS and Premera BCBS typically classify interspinous fixation devices as investigational, requiring thorough justification and appeals for coverage.
• Credence BCBS states clearly to utilize CPT 22899 for this procedure, as no dedicated CPT exists yet.

Sample Policies:

• UnitedHealthcare Interspinous Fusion Devices Policy:
  https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/interspinous-fusion-decompression-devices.pdf
• Credence BCBS Medical Policy:
  https://policies.credenceblue.com

5. Example of a Billing & Coding ScenarioClinical Scenario:
A 65-year-old patient presents with lumbar spinal stenosis and Grade 1 spondylolisthesis at L4-L5, causing severe neurogenic claudication and significant functional limitation. Conservative treatments (physical therapy, medications, and epidural injections) over six months have provided inadequate relief. A decision is made for spinal stabilization using the Minuteman® device.

Coding & Billing Example:

• CPT Codes:
  • 22612 (Arthrodesis, posterior lumbar)
  • 22840 (Posterior instrumentation, non-segmental)
  • 22899 (If specifically requested by payer)
• ICD-10 Diagnosis Codes:
  • M48.061 – Lumbar spinal stenosis with neurogenic claudication
  • M43.16 – Lumbar spondylolisthesis

Claim Submission Example:

• Include operative notes detailing the surgical procedure, clearly describing implant insertion, stabilization, and any additional instrumentation.
• Provide comprehensive patient clinical records, imaging reports, and previous conservative therapy notes.

​
Reference: ​https://spinalsimplicity.com/wp-content/uploads/2025/02/L250-Minuteman-Billing-Guidance-2025-Rev1.pdf

You can Learn Billing and Coding Peripheral Nerve Block CPT 64450, 64405, 64420, 64447, 64418. This article includes ICD-10 Crossover Codes, Global Periods, Imaging Guidance, Modifiers, Utilization Guidelines, Bundling/Unbundling, and Insurance Payer Policies.

​Accurate billing for peripheral nerve blocks is essential for ensuring compliance and maximizing reimbursement. This guide provides detailed information on CPT codes, ICD-10 crossover codes, imaging guidance, and modifiers, along with utilization guidelines, bundling/unbundling rules, and insurance payer policies. It's important to verify specific requirements with each payer, as policies can vary.

1. CPT 64400 - Trigeminal Nerve Block

• Description: Injection of an anesthetic into the branches of the trigeminal nerve, often used to treat facial pain or trigeminal neuralgia.
• ICD-10 Crossover Codes:
  • G50.0 - Trigeminal Neuralgia
  • R51 - Headache
• Global Period: 0 days
• Imaging Guidance:
  • CPT 76942 - Ultrasonic guidance
  • CPT 77002 - Fluoroscopic guidance
• Modifiers:
  • -RT (Right side) or -LT (Left side) for laterality
  • -59 (Distinct Procedural Service) if necessary to indicate a separate and distinct service
• Utilization Guidelines: Typically used for acute pain management in facial regions.
• Frequency Limits: Usually limited to 3-4 injections per year unless there is a documented need for additional treatments.
• Bundling/Unbundling:
  • Bundling: Imaging guidance is typically not bundled and should be billed separately.
  • Unbundling: Ensure distinct services are properly coded with modifiers to avoid inappropriate bundling.
• Insurance Payer Policies: Often covered when medically necessary, particularly in cases of chronic or intractable facial pain. Clarification with payers is recommended to confirm the frequency limits, preauthorization requirements, and any payer-specific guidelines.

2. CPT 64405 - Occipital Nerve Block

• Description: Injection into the greater or lesser occipital nerves to manage chronic headaches or occipital neuralgia.
• ICD-10 Crossover Codes:
  • G44.84 - Occipital Neuralgia
  • R51 - Headache
• Global Period: 0 days
• Imaging Guidance:
  • CPT 76942 - Ultrasonic guidance
  • CPT 77002 - Fluoroscopic guidance
• Modifiers:
  • -RT (Right side) or -LT (Left side) for laterality
  • -50 (Bilateral Procedure) if performed bilaterally
  • -59 (Distinct Procedural Service) if needed to indicate a separate service
• Utilization Guidelines: Primarily used in patients with chronic headache disorders unresponsive to other treatments.
• Frequency Limits: Typically limited to 3-4 injections per year; additional treatments may require justification.
• Bundling/Unbundling:
  • Bundling: Imaging guidance is generally billed separately from the nerve block procedure.
  • Unbundling: Ensure distinct procedures are appropriately coded to avoid denials.
• Insurance Payer Policies: Generally covered when conservative treatments have failed, and the patient has a documented history of chronic headaches. Clarification with payers is necessary to understand coverage details, including any preauthorization requirements and frequency limitations.

3. CPT 64415 - Brachial Plexus Block

• Description: Injection into the brachial plexus for anesthesia or pain relief in the upper extremity.
• ICD-10 Crossover Codes:
  • M25.511 - Pain in right shoulder
  • M54.2 - Cervicalgia
• Global Period: 0 days
• Imaging Guidance:
  • CPT 76942 - Ultrasonic guidance
  • CPT 77002 - Fluoroscopic guidance
• Modifiers:
  • -RT (Right side) or -LT (Left side) for laterality
  • -50 (Bilateral Procedure) if performed on both sides
  • -59 (Distinct Procedural Service) for additional distinct services
• Utilization Guidelines: Commonly used for surgical anesthesia or in the management of chronic pain conditions affecting the shoulder or arm.
• Frequency Limits: Typically limited to 3-4 injections annually unless there is a documented need for more frequent treatment.
• Bundling/Unbundling:
  • Bundling: Imaging guidance is usually billed separately unless explicitly bundled by payer-specific rules.
  • Unbundling: Make sure distinct services are unbundled and coded separately to prevent bundling issues.
• Insurance Payer Policies: Coverage is typically provided for surgical pain management and chronic pain, especially when conservative therapies are insufficient. Clarification with payers is recommended to confirm any specific preauthorization requirements and whether imaging guidance is covered separately.

4. CPT 64445 - Sciatic Nerve Block

• Description: Injection into the sciatic nerve for pain management in the lower extremity.
• ICD-10 Crossover Codes:
  • M54.31 - Sciatica, right side
  • M54.32 - Sciatica, left side
• Global Period: 0 days
• Imaging Guidance:
  • CPT 76942 - Ultrasonic guidance
  • CPT 77002 - Fluoroscopic guidance
• Modifiers:
  • -RT (Right side) or -LT (Left side) for laterality
  • -50 (Bilateral Procedure) if performed on both sides
  • -59 (Distinct Procedural Service) to indicate a separate service
• Utilization Guidelines: Primarily used for lower extremity surgeries or chronic sciatica management.
• Frequency Limits: Usually limited to 3-4 blocks per year; further blocks require additional justification.
• Bundling/Unbundling:
  • Bundling: Imaging guidance is generally unbundled and should be billed separately.
  • Unbundling: Use modifiers correctly to indicate distinct procedural services when necessary.
• Insurance Payer Policies: Generally covered when conservative treatment has failed or for surgical anesthesia. Detailed documentation of the patient’s condition and treatment history is often required. Clarification with payers is important to determine specific coverage criteria, including any bundling rules and preauthorization needs.

5. CPT 64447 - Femoral Nerve Block

• Description: Injection into the femoral nerve for anesthesia or pain relief in the thigh, knee, or hip.
• ICD-10 Crossover Codes:
  • M25.561 - Pain in right knee
  • M25.562 - Pain in left knee
• Global Period: 0 days
• Imaging Guidance:
  • CPT 76942 - Ultrasonic guidance
  • CPT 77002 - Fluoroscopic guidance
• Modifiers:
  • -RT (Right side) or -LT (Left side) for laterality
  • -50 (Bilateral Procedure) if performed on both sides
  • -59 (Distinct Procedural Service) if needed to indicate a separate service
• Utilization Guidelines: Commonly used for post-surgical pain management or chronic pain in the lower extremities.
• Frequency Limits: Generally limited to 3-4 injections per year, with additional treatments requiring further documentation.
• Bundling/Unbundling:
  • Bundling: Imaging guidance is typically not bundled and should be billed separately.
  • Unbundling: Ensure that each service is correctly unbundled if needed and that distinct procedural services are coded separately.
• Insurance Payer Policies: Coverage is generally provided when there is documented pain or surgical need in the lower extremities. Clarification with payers is necessary to confirm frequency limits and any specific requirements for imaging guidance and documentation.

6. CPT 64450 - Other Peripheral Nerve Block

• Description: Injection into any other peripheral nerve or branch not specifically listed above.
• ICD-10 Crossover Codes:
  • M79.2 - Neuralgia and neuritis, unspecified
  • M25.569 - Pain in unspecified knee
• Global Period: 0 days
• Imaging Guidance:
  • CPT 76942 - Ultrasonic guidance
  • CPT 77002 - Fluoroscopic guidance
• Modifiers:
  • -RT (Right side) or -LT (Left side) for laterality
  • -59 (Distinct Procedural Service) if needed to indicate a separate service
• Utilization Guidelines: Used for various peripheral nerve blocks not covered by more specific CPT codes.
• Frequency Limits: Typically limited to 3-4 times annually, with additional procedures requiring further justification.
• Bundling/Unbundling:
  • Bundling: Imaging guidance is generally billed separately unless specifically bundled by payer policy.
  • Unbundling: Ensure distinct procedural services are correctly unbundled when necessary.
• Insurance Payer Policies: Coverage is typically provided when other specific nerve blocks are not applicable or when treating less common pain syndromes. Clarification with payers is recommended to confirm coverage, frequency limitations, and any specific bundling rules.

Insurance policies vary by payer, and it's crucial to clarify with each payer their specific coverage guidelines, including:

• Preauthorization Requirements: Some payers require preauthorization for nerve block procedures, particularly if they are repeated or combined with imaging guidance.
• Frequency Limits: Verify the number of injections covered per year, as some payers may impose stricter limits or require additional documentation for frequent treatments.
• Bundling Rules: Ensure you understand each payer’s bundling policies, particularly regarding imaging guidance, to avoid denials and ensure proper reimbursement.
• Documentation Requirements: Thorough documentation is critical, including the patient’s diagnosis, treatment history, and response to previous procedures. This documentation supports the medical necessity of the nerve block and helps prevent claim denials.

By following these guidelines and staying informed about payer-specific policies, healthcare providers can ensure accurate billing, compliance, and optimal reimbursement for peripheral nerve block procedures in 2024 and in 2025.

Here are the spelled-out URLs for the references provided:

1. American Medical Association (AMA) - CPT® Code Set:
   
   • Website: https://www.ama-assn.org/delivering-care/cpt-current-procedural-terminology
2. Centers for Medicare & Medicaid Services (CMS) - Medicare Coverage Database:
   
   • Website: https://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx
3. ICD-10-CM Official Guidelines for Coding and Reporting:
   
   • Website: https://www.cdc.gov/nchs/icd/icd10cm.htm
4. National Correct Coding Initiative (NCCI) - CMS:
   
   • Website: https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits
5. Local Coverage Determinations (LCDs) - CMS:
   
   • Website: https://www.cms.gov/medicare-coverage-database/search/lcd-search.aspx
6. Payer-Specific Medical Policies:
   
   • Aetna Clinical Policy Bulletins: https://www.aetna.com/health-care-professionals/clinical-policy-bulletins.html
   • UnitedHealthcare Policies: https://www.uhcprovider.com/en/policies-protocols.html
   • Blue Cross Blue Shield Medical Policies: https://www.bcbs.com/learn/health-insurance-basics/what-are-medical-policy-and-medical-necessity

​Billing and coding for Minimally Invasive Lumbar Decompression (MILD) procedures is a complex process requiring detailed understanding of procedural codes, diagnosis codes, documentation requirements, and adherence to clinical guidelines. This comprehensive guide will cover these aspects in depth, ensuring a clear understanding of the entire process.

Introduction to MILD Procedures
Minimally Invasive Lumbar Decompression (MILD) is a surgical technique used to treat lumbar spinal stenosis. This condition involves the narrowing of the spinal canal, which can compress nerves and lead to pain, numbness, or weakness in the lower back and legs. The MILD procedure aims to relieve this pressure with minimal tissue disruption, making it a preferred option for many patients.
Billing and Coding for MILD Procedures
CPT Codes for MILD Procedures
The Current Procedural Terminology (CPT) codes are essential for accurately billing medical procedures. For MILD procedures, the primary CPT code is:

• CPT Code 0275T: This code is designated for percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, any method under indirect image guidance (e.g., fluoroscopic, CT), with or without the use of an endoscope.

The use of this code indicates that the procedure was performed percutaneously, utilizing imaging guidance to achieve neural decompression. It's crucial to ensure that this code accurately reflects the procedure performed, as incorrect coding can lead to claim denials or delays in reimbursement.
ICD-10 Codes for Diagnoses
In addition to procedural codes, International Classification of Diseases, Tenth Revision (ICD-10) codes must be used to identify the patient’s diagnosis. Common ICD-10 codes for conditions treated with MILD procedures include:

• M48.061: Spinal stenosis, lumbar region with neurogenic claudication. This code is used when the patient presents with lumbar spinal stenosis causing claudication, a common symptom involving pain and cramping in the legs due to inadequate blood flow.
• M43.16: Spondylolisthesis, lumbar region. This code is used for lumbar spondylolisthesis, a condition where a vertebra slips forward over the one below it, often causing spinal stenosis and nerve compression.

These codes should be selected based on a thorough assessment and diagnostic confirmation, ensuring that the chosen code best represents the patient's condition.

Accurate and thorough documentation is critical for successful billing and reimbursement. The documentation should provide a clear and comprehensive picture of the patient’s condition, the necessity of the procedure, and the details of the procedure itself.
Key Components of Documentation

1. Patient History and Physical Examination: This section should detail the patient’s medical history, including any previous treatments for lumbar spinal stenosis, and the findings of the physical examination. Symptoms, duration, and impact on the patient’s daily life should be noted.
   
2. Imaging Studies: Documentation should include the results of imaging studies, such as MRI or CT scans, that confirm the diagnosis of lumbar spinal stenosis. These images should clearly show the areas of stenosis and nerve compression.
   
3. Operative Report: The operative report should detail the procedure performed, including the approach, technique, and tools used. Specifics such as the level of the spine treated and the use of fluoroscopic or CT guidance should be included.
   
4. Post-Operative Care: Instructions for post-operative care, including any medications prescribed, activity restrictions, and follow-up appointments, should be documented. This helps in monitoring the patient’s recovery and managing any complications.
   
5. Medical Necessity: The documentation must justify the medical necessity of the MILD procedure. This includes outlining the conservative treatments attempted prior to surgery and explaining why they were insufficient.
   

Clinical Guidelines and Resources
Adhering to clinical guidelines is essential to ensure that the MILD procedure is medically necessary and performed according to best practices. Here are some relevant guidelines and resources:
Medicare Local Coverage Determinations (LCDs)
Local Coverage Determinations (LCDs) are policies developed by Medicare Administrative Contractors (MACs) that provide guidance on the coverage of specific procedures. These policies can vary by region, so it’s important to refer to the LCDs applicable to the provider’s location. LCDs typically include information on covered indications, documentation requirements, and billing guidelines for the MILD procedure.
National Coverage Determinations (NCDs)
National Coverage Determinations (NCDs) provide national policy on whether Medicare will pay for an item or service. Although there may not be a specific NCD for the MILD procedure, general guidelines for spine surgery can be helpful. For instance, the NCD for Lumbar Spinal Fusion Surgery provides criteria that can be relevant for determining the medical necessity of procedures addressing spinal stenosis.

• NCD for Lumbar Spinal Fusion Surgery: Detailed information can be found on the CMS website.

American Society of Interventional Pain Physicians (ASIPP) Guidelines
The ASIPP provides guidelines for interventional pain procedures, including those for lumbar spinal stenosis. These guidelines offer evidence-based recommendations on patient selection, procedural techniques, and post-procedure care. 

Clinical Guidelines on the Management of Lumbar Spinal Stenosis
Clinical guidelines on the management of lumbar spinal stenosis offer comprehensive information on the diagnosis and treatment options for this condition. These guidelines are often developed by professional organizations and can be accessed through medical journals or databases like PubMed.
Medicare and CMS Guidelines
Compliance with Medicare and CMS guidelines is crucial for accurate billing and reimbursement. Providers should familiarize themselves with the following resources:
CMS Manual SystemThe CMS Manual System includes the Medicare Claims Processing Manual and the Medicare Program Integrity Manual. These manuals provide detailed information on billing and coding practices, including specific instructions for surgical procedures like the MILD procedure.

• Medicare Claims Processing Manual: This manual provides guidance on the proper submission of claims, coding, and documentation requirements. It is accessible on the CMS website here.

National Correct Coding Initiative (NCCI) Edits
The NCCI edits are designed to promote correct coding methodologies and prevent improper coding that leads to inappropriate payment. Providers should ensure that they are in compliance with these edits to avoid claim denials. 

Detailed Explanation of the MILD Procedure
Understanding the clinical aspects of the MILD procedure helps in accurate documentation and justification of its medical necessity.

Indications for MILD Procedure
The primary indication for the MILD procedure is lumbar spinal stenosis causing neurogenic claudication. Patients typically present with symptoms such as:

• Pain in the lower back, buttocks, and legs, which worsens with walking or standing.
• Numbness, tingling, or weakness in the lower extremities.
• Relief of symptoms when sitting or bending forward, known as the "shopping cart sign."

Preoperative Evaluation
A thorough preoperative evaluation is essential to confirm the diagnosis and assess the suitability of the patient for the MILD procedure. This includes:

1. Clinical Assessment: Detailed patient history and physical examination.
2. Imaging Studies: MRI or CT scans to visualize the degree of spinal stenosis and identify the exact location of nerve compression.
3. Conservative Treatments: Documentation of previous conservative treatments such as physical therapy, medications, and epidural steroid injections, and their outcomes.

Surgical Technique
The MILD procedure is performed using specialized instruments to remove small portions of bone and ligament through a tiny incision, relieving pressure on the spinal nerves. The key steps include:

1. Patient Positioning: The patient is positioned prone on the operating table.
2. Anesthesia: Local anesthesia with sedation or general anesthesia may be used.
3. Imaging Guidance: Fluoroscopic or CT guidance is employed to accurately target the area of stenosis.
4. Incision and Instrumentation: A small incision is made, and a cannula is inserted to access the spinal canal. Specialized tools are used to remove portions of the ligamentum flavum and lamina.
5. Decompression: The decompression is confirmed using imaging guidance, ensuring adequate space for the spinal nerves.
6. Closure: The incision is closed with sutures or surgical glue, and a sterile dressing is applied.

Postoperative Care
Postoperative care involves monitoring the patient for complications, managing pain, and providing instructions for activity modification. Follow-up appointments are essential to assess the patient’s recovery and address any concerns.
​
Importance of Compliance and Accurate Coding
Compliance with billing and coding guidelines is not only crucial for reimbursement but also for avoiding legal and financial repercussions. Accurate coding ensures that the healthcare provider is appropriately compensated for the services rendered, while also preventing issues such as:

• Claim Denials: Incorrect or incomplete coding can result in claim denials, delaying reimbursement and increasing administrative burdens.
• Audits and Investigations: Non-compliance with coding guidelines can trigger audits and investigations by payers, potentially leading to penalties and fines.
• Revenue Loss: Inaccurate coding can lead to underpayment, affecting the financial health of the practice.

Common Challenges and Solutions Providers may face several challenges in billing and coding for MILD procedures. Here are some common issues and solutions:

Challenge 1: Staying Updated with Coding ChangesCoding guidelines and reimbursement policies are subject to frequent changes. Keeping up with these changes can be challenging but is essential for compliance.
Solution: Regularly subscribe to updates from professional organizations, CMS newsletters, and coding resources. Attend workshops and webinars to stay informed about the latest changes in billing and coding practices.
Challenge 2: Ensuring Thorough DocumentationIncomplete or inaccurate documentation can lead to claim denials and compliance issues.
Solution: Implement standardized documentation templates that include all necessary components such as patient history, imaging studies, procedural details, and post-operative care. Regular training sessions for staff on documentation best practices can also help.
Challenge 3: Proper Use of CPT and ICD-10 CodesSelecting the correct CPT and ICD-10 codes for the MILD procedure and associated diagnoses is crucial for accurate billing.
Solution: Use coding software and tools that assist in selecting the appropriate codes based on the documented procedure and diagnosis. Regularly review coding guidelines and ensure that coders are certified and well-trained.
Challenge 4: Meeting Medical Necessity RequirementsProving medical necessity is essential for reimbursement. Insufficient evidence can result in denied claims.
Solution: Ensure that the documentation includes detailed information about the patient’s condition, previous treatments, and why the MILD procedure is necessary. Adhere to clinical guidelines and payer policies when determining medical necessity.

Following best practices can significantly enhance the accuracy and efficiency of billing and coding for MILD procedures.
1. Use Detailed and Clear Documentation
Comprehensive documentation should include the following:

• Patient History and Symptoms: Detailed information about the patient's symptoms, their duration, and impact on daily activities.
• Diagnostic Imaging: Clear documentation of imaging studies that confirm the diagnosis of lumbar spinal stenosis.
• Procedure Details: A step-by-step account of the MILD procedure, including the approach, techniques used, and imaging guidance.
• Post-Operative Care: Detailed post-operative instructions and follow-up care plans.

2. Regular Training and Education
Continuous education and training for coding staff, physicians, and administrative personnel are crucial. This includes:

• Workshops and Seminars: Attend coding workshops and seminars to stay updated on the latest coding practices and guidelines.
• Online Courses: Utilize online courses and webinars for ongoing education.
• In-House Training: Conduct regular in-house training sessions to address common coding issues and updates.

3. Leverage Technology
Utilize technology to streamline the billing and coding process:

• Coding Software: Implement coding software that assists in selecting the appropriate codes based on the documented procedure and diagnosis.
• Electronic Health Records (EHRs): Use EHRs to ensure accurate and complete documentation. EHR systems can also prompt for missing information, reducing the risk of incomplete documentation.
• Auditing Tools: Use auditing tools to regularly review and ensure compliance with coding guidelines.

4. Compliance Programs
​Establish a compliance program to monitor and enforce adherence to coding and billing guidelines. This includes:

• Regular Audits: Conduct regular internal audits to identify and correct coding errors.
• Compliance Officers: Appoint compliance officers to oversee the adherence to coding and billing practices.
• Policies and Procedures: Develop and implement policies and procedures that outline the correct coding and billing practices.

Medicare and CMS Resources
Medicare and CMS offer various resources that can assist in the billing and coding process for MILD procedures.

CMS Manual System
The CMS Manual System includes several manuals that provide detailed information on billing and coding practices. These manuals are essential for understanding Medicare policies and ensuring compliance.

• Medicare Claims Processing Manual: This manual provides guidance on the proper submission of claims, coding, and documentation requirements. It is accessible on the CMS website here.

National Correct Coding Initiative (NCCI) Edits
NCCI edits are designed to promote correct coding methodologies and prevent improper coding that leads to inappropriate payment. Providers should ensure compliance with these edits to avoid claim denials.

• NCCI Edits: Detailed information on NCCI edits is available here.

Clinical Guidelines and Best PracticesAdhering to clinical guidelines ensures that the MILD procedure is performed according to best practices and is medically necessary.
American Society of Interventional Pain Physicians (ASIPP) GuidelinesThe ASIPP provides evidence-based guidelines for interventional pain procedures, including those for lumbar spinal stenosis. These guidelines offer recommendations on patient selection, procedural techniques, and post-procedure care.

• ASIPP Guidelines: 

Clinical Guidelines on the Management of Lumbar Spinal Stenosis
These guidelines provide comprehensive information on the diagnosis and treatment options for lumbar spinal stenosis. They are often developed by professional organizations and can be accessed through medical journals or databases like PubMed.

• Clinical Guidelines: Search for relevant articles on PubMed here.

ConclusionBilling and coding for MILD procedures require a detailed understanding of CPT and ICD-10 codes, thorough documentation, adherence to clinical guidelines, and compliance with Medicare and CMS policies. By following best practices and leveraging available resources, healthcare providers can ensure accurate billing, timely reimbursement, and improved patient care. Regular training, use of technology, and a robust compliance program are key components to achieving success in this complex process.

​This sample medical necessity letter outlines the benefits of Minimally-Invasive SI Joint Fusion as a treatment for chronic low back pain. It includes detailed patient history, physical examination, and imaging results to support the request for prior authorization. Written in a professional tone, this letter provides a compelling case for the minimally invasive procedure and can serve as a helpful reference for healthcare providers seeking authorization from insurance companies.

[Date]
[Recipient's Name]
[Insurance Company Name]
[Address]
[City, State, ZIP Code]

Patient: [Patient's Full Name]
Date of Birth: [DOB]
Policy Number: [Policy Number]
Group Number: [Group Number]
​Re: Medical Necessity for Minimally-Invasive SI Joint Procedure
Procedure Code: [ CPT Code ]
Diagnosis Code: [ DX Code ]

Dear [Recipient's Name],
​
I am writing to request pre-authorization for a minimally-invasive sacroiliac (SI) joint procedure for my patient, [Patient's Full Name]. As the rendering physician, I have been treating [Patient's Full Name] for chronic SI joint pain and dysfunction. This letter is intended to provide you with the relevant information about [his/her/their] condition and the rationale for the proposed procedure.
History: [Patient's Full Name] has been experiencing persistent lower back and buttock pain for the past [number of months/years]. The pain is particularly aggravated by activities such as prolonged sitting, standing, and walking, which has severely limited [his/her/their] ability to perform daily activities and maintain a satisfactory quality of life. [Patient's Full Name] has also reported sleep disturbances due to the pain.
Physical Examination: A thorough physical examination revealed localized tenderness and pain over the SI joint, positive FABER test, and positive compression test. These findings, in conjunction with the patient's history, are consistent with SI joint dysfunction.
MRI and Imaging Results: An MRI scan was performed on [Date] and confirmed the presence of SI joint inflammation and degeneration. Additional imaging, including X-rays and CT scans, also revealed irregular joint surfaces and sclerosis, which are indicative of SI joint dysfunction.
Failed Conservative Treatments: [Patient's Full Name] has undergone numerous conservative treatment options without adequate relief from the symptoms. These treatments have included but are not limited to:

1. Physical therapy
2. Non-steroidal anti-inflammatory medications (NSAIDs)
3. Oral corticosteroids
4. SI joint injections
5. Activity modification and pain management education

Unfortunately, despite these efforts, [Patient's Full Name] continues to experience debilitating pain and limited functionality.
Based on [Patient's Full Name]'s clinical history, physical examination findings, and imaging results, it is my medical opinion that a minimally-invasive SI joint procedure is medically necessary. This procedure has a high success rate in reducing pain and improving functionality for patients with SI joint dysfunction who have failed conservative treatments.
Impact on Quality of Life: [Patient's Full Name]'s chronic SI joint pain has not only affected [his/her/their] physical well-being, but also [his/her/their] emotional and mental health. The persistent pain and limited mobility have led to social isolation, increased stress levels, and feelings of depression. This procedure is crucial to help [Patient's Full Name] regain [his/her/their] quality of life and prevent further deterioration of [his/her/their] overall well-being.
Minimally-Invasive Procedure Benefits: The minimally-invasive SI joint procedure offers several advantages compared to traditional open surgery. These benefits include:

1. Shorter hospital stay
2. Reduced postoperative pain
3. Faster recovery time
4. Lower risk of complications and infection
5. Minimal scarring

By authorizing this procedure, [Patient's Full Name] will have the opportunity to benefit from these advantages, which will contribute to a quicker return to [his/her/their] daily activities and a reduced risk of complications.
Economic Impact: It is also important to consider the economic impact of [Patient's Full Name]'s chronic SI joint pain. Due to the severity of [his/her/their] condition, [Patient's Full Name] has been unable to work and maintain a consistent income. Authorizing this procedure will likely enable [Patient's Full Name] to return to work sooner, reducing the financial burden on [him/her/them] and [his/her/their] family.
Minimally Invasive SI Joint Surgery: Overview and Benefits:
Minimally invasive sacroiliac (SI) joint surgery, also known as SI joint fusion or stabilization, is a cutting-edge procedure that aims to alleviate pain and restore function in patients suffering from chronic SI joint dysfunction. This innovative technique has emerged as a reliable and effective treatment option for patients who have not experienced adequate relief from conservative therapies.
The sacroiliac joint is the connection between the sacrum (the triangular bone at the base of the spine) and the ilium (the large, wing-shaped bone that forms the pelvis). Dysfunction in the SI joint can lead to debilitating pain and reduced mobility. Minimally invasive SI joint surgery involves the use of specialized instruments and techniques to stabilize the affected joint, thus alleviating pain and allowing the patient to regain their quality of life.
Benefits of Minimally Invasive SI Joint Surgery:

1. Reduced tissue trauma: Unlike traditional open surgery, which requires a large incision and extensive muscle dissection, the minimally invasive approach utilizes small incisions and specialized instruments to access the SI joint. This results in less trauma to the surrounding tissues and a lower risk of complications.
2. Shorter hospital stay: Due to the less invasive nature of the procedure, patients typically require a shorter hospital stay. This allows them to return to the comfort of their own homes and begin their recovery process sooner.
3. Faster recovery: Minimally invasive SI joint surgery generally results in a quicker recovery period, as patients experience less postoperative pain and tissue damage. This enables them to return to their normal activities and work more quickly, reducing the overall impact on their lives.
4. Lower risk of complications: The minimally invasive technique reduces the risk of complications associated with traditional open surgery, such as infection, blood loss, and nerve damage. This contributes to a safer and more predictable surgical outcome.
5. Minimal scarring: Small incisions used in minimally invasive SI joint surgery result in minimal scarring, providing an added cosmetic benefit to the patient.

In summary, minimally invasive SI joint surgery is a highly effective procedure for treating patients with chronic SI joint dysfunction who have not found relief through conservative treatments. The numerous benefits of this approach, including reduced tissue trauma, shorter hospital stays, faster recovery, lower risk of complications, and minimal scarring, make it a superior choice for patients seeking lasting relief from their SI joint pain and improved quality of life.

Reference Source: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=55036&ver=59
Billing and Coding: Hyaluronan Acid Therapies for Osteoarthritis of the Knee
CPT 2022. CPT is a trademark and owned by the AMA - American Medical Association.

​CPT Codes to Report (based on Medical Necessity and Service(s) Performed:

63650 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY, EPIDURAL
63655 LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, PLATE/PADDLE, EPIDURAL
63663 REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S), INCLUDING FLUOROSCOPY, WHEN PERFORMED
63664 REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED
63685 INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT OR INDUCTIVE COUPLING

According to CMS Utilization Guidelines:

Utilization Guidelines (most commercial payers also follow this guidelines):

63650 - Two temporary spinal cord stimulator trials per anatomic spinal region (two per DOS) or (four units) per patient per lifetime (with exceptions allowed for technical limitations for the initial trials or for use of different modalities of stimulation, including new technology), in place of service office, ASC, out-patient hospital, or hospital. Since permanent neurostimulator arrays can also be placed percutaneously, code 63650 can be covered more often in place of service ASC, out-patient hospital, or hospital.

63655 - One permanent spinal cord stimulator per patient per lifetime and must be performed in an ASC, out-patient hospital or hospital.

63663 - Will not be reimbursed in the office setting since they are included in 63650.

​Common ICD-10 Codes Cross-over meeting Medical Necessity:
M51.16 Intervertebral disc disorders with radiculopathy, lumbar region
M51.17 Intervertebral disc disorders with radiculopathy, lumbosacral region
M51.24 Other intervertebral disc displacement, thoracic region
M51.25 Other intervertebral disc displacement, thoracolumbar region
M51.26 Other intervertebral disc displacement, lumbar region
M51.27 Other intervertebral disc displacement, lumbosacral region
M54.11 Radiculopathy, occipito-atlanto-axial region
M54.12 Radiculopathy, cervical region
M54.13 Radiculopathy, cervicothoracic region
M54.14 Radiculopathy, thoracic region
M54.15 Radiculopathy, thoracolumbar region
M54.16 Radiculopathy, lumbar region
M54.17 Radiculopathy, lumbosacral region
M54.18 Radiculopathy, sacral and sacrococcygeal region
M96.1 Postlaminectomy syndrome, not elsewhere classified

Reference: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57792&ver=6

CPT CODE BOOK: 2021 and 2022
ICD-10 GUIDELINE: 2021

SCS Vendors Useful Links:
Boston Scientific Interventional Pain Management Products
Medtronic Spinal Stimulation Systems 
NALU NeuroStimulation
St. Jude Medical NeuroStimulation Systems (Abbott)
​

​62281 INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOLUTIONS), WITH OR WITHOUT OTHER THERAPEUTIC SUBSTANCE; EPIDURAL, CERVICAL OR THORACIC
62320 INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, CERVICAL OR THORACIC; WITHOUT IMAGING GUIDANCE
62321 INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, CERVICAL OR THORACIC; WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT)
62324 INJECTION(S), INCLUDING INDWELLING CATHETER PLACEMENT, CONTINUOUS INFUSION OR INTERMITTENT BOLUS, OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INTERLAMINAR EPIDURAL OR SUBARACHNOID, CERVICAL OR THORACIC; WITHOUT IMAGING GUIDANCE
62325 INJECTION(S), INCLUDING INDWELLING CATHETER PLACEMENT, CONTINUOUS INFUSION OR INTERMITTENT BOLUS, OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INTERLAMINAR EPIDURAL OR SUBARACHNOID, CERVICAL OR THORACIC; WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT)

Sharing to you all pain management billing codes we have been utilizing helping our pain practice offices, surgery centers and our physicians clients! Let me know if you have any questions, concerns or confusion on how to report these codes properly. We have been in this world of Pain Management Practice Operations and Documentation for more than 20 years!

The truth is, Pain Management billing codes are not easy to utilize if you don't know how to use them. It is always useful that you understand your physicians documentations and their procedures. Most of these codes are unilateral. Most of these codes are based on utilization and frequency guidance. So make sure you know all your payers guidelines for clinical and reimbursement. 

Let me know if you need me! But here are you codes! 

62321 INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, CERVICAL OR THORACIC; WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT)
62323 INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, LUMBAR OR SACRAL (CAUDAL); WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT)

64490 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SINGLE LEVEL
+64491 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
+64492 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
64493 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SINGLE LEVEL
+64494 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
+64495 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

64633 DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); CERVICAL OR THORACIC, SINGLE FACET JOINT
+64634 DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); CERVICAL OR THORACIC, EACH ADDITIONAL FACET JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
64635 DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, SINGLE FACET JOINT
+64636 DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, EACH ADDITIONAL FACET JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

64400 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRIGEMINAL NERVE, EACH BRANCH (IE, OPHTHALMIC, MAXILLARY, MANDIBULAR)
64405 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GREATER OCCIPITAL NERVE
64415 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; BRACHIAL PLEXUS
64416 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; BRACHIAL PLEXUS, CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETER PLACEMENT)
64417 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; AXILLARY NERVE
64418 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SUPRASCAPULAR NERVE
64420 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; INTERCOSTAL NERVE, SINGLE LEVEL
+64421 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; INTERCOSTAL NERVE, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
64425 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; ILIOINGUINAL, ILIOHYPOGASTRIC NERVES
64430 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; PUDENDAL NERVE
64445 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SCIATIC NERVE
64446 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SCIATIC NERVE, CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETER PLACEMENT)
64447 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; FEMORAL NERVE
64448 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; FEMORAL NERVE, CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETER PLACEMENT)
64449 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; LUMBAR PLEXUS, POSTERIOR APPROACH, CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETER PLACEMENT)
64450 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; OTHER PERIPHERAL NERVE OR BRANCH
64454 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GENICULAR NERVE BRANCHES, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED
64455 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; PLANTAR COMMON DIGITAL NERVE(S) (EG, MORTON'S NEUROMA)
64624 DESTRUCTION BY NEUROLYTIC AGENT, GENICULAR NERVE BRANCHES INCLUDING IMAGING GUIDANCE, WHEN PERFORMED
64620 DESTRUCTION BY NEUROLYTIC AGENT, INTERCOSTAL NERVE
64640 DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH
64999 UNLISTED PROCEDURE, NERVOUS SYSTEM

Related Imaging Pain Management Billing Codes:
76881 ULTRASOUND, COMPLETE JOINT (IE, JOINT SPACE AND PERI-ARTICULAR SOFT-TISSUE STRUCTURES), REAL-TIME WITH IMAGE DOCUMENTATION
76882 ULTRASOUND, LIMITED, JOINT OR OTHER NONVASCULAR EXTREMITY STRUCTURE(S) (EG, JOINT SPACE, PERI-ARTICULAR TENDON[S], MUSCLE[S], NERVE[S], OTHER SOFT-TISSUE STRUCTURE[S], OR SOFT-TISSUE MASS[ES]), REAL-TIME WITH IMAGE DOCUMENTATION
76942 ULTRASONIC GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION, LOCALIZATION DEVICE), IMAGING SUPERVISION AND INTERPRETATION
76999 UNLISTED ULTRASOUND PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL)
97032 APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ELECTRICAL STIMULATION (MANUAL), EACH 15 MINUTES
97139 UNLISTED THERAPEUTIC PROCEDURE (SPECIFY)
G0282 ELECTRICAL STIMULATION, (UNATTENDED), TO ONE OR MORE AREAS, FOR WOUND CARE OTHER THAN DESCRIBED IN G0281
G0283 ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE

63650 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY, EPIDURAL
63655 LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, PLATE/PADDLE, EPIDURAL
63663 REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S), INCLUDING FLUOROSCOPY, WHEN PERFORMED
63664 REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED
63685 INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT OR INDUCTIVE COUPLING

Pay Attention to Medicare's Utilization Guidelines. This is also being utilized by most payers!

63650 - Two temporary spinal cord stimulator trials per anatomic spinal region (two per DOS) or (four units) per patient per lifetime (with exceptions allowed for technical limitations for the initial trials or for use of different modalities of stimulation, including new technology), in place of service office, ASC, out-patient hospital, or hospital. Since permanent neurostimulator arrays can also be placed percutaneously, code 63650 can be covered more often in place of service ASC, out-patient hospital, or hospital.

63655 - One permanent spinal cord stimulator per patient per lifetime and must be performed in an ASC, out-patient hospital or hospital.

63663 - Will not be reimbursed in the office setting since they are included in 63650.

​22510 PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION, INCLUSIVE OF ALL IMAGING GUIDANCE; CERVICOTHORACIC
22511 PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION, INCLUSIVE OF ALL IMAGING GUIDANCE; LUMBOSACRAL
+22512 PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION, INCLUSIVE OF ALL IMAGING GUIDANCE; EACH ADDITIONAL CERVICOTHORACIC OR LUMBOSACRAL VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
22513 PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG, KYPHOPLASTY), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION, INCLUSIVE OF ALL IMAGING GUIDANCE; THORACIC
22514 PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG, KYPHOPLASTY), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION, INCLUSIVE OF ALL IMAGING GUIDANCE; LUMBAR
+22515 PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG, KYPHOPLASTY), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION, INCLUSIVE OF ALL IMAGING GUIDANCE; EACH ADDITIONAL THORACIC OR LUMBAR VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

64612 CHEMODENERVATION OF MUSCLE(S); MUSCLE(S) INNERVATED BY FACIAL NERVE, UNILATERAL (EG, FOR BLEPHAROSPASM, HEMIFACIAL SPASM)
64615 CHEMODENERVATION OF MUSCLE(S); MUSCLE(S) INNERVATED BY FACIAL, TRIGEMINAL, CERVICAL SPINAL AND ACCESSORY NERVES, BILATERAL (EG, FOR CHRONIC MIGRAINE)
64616 CHEMODENERVATION OF MUSCLE(S); NECK MUSCLE(S), EXCLUDING MUSCLES OF THE LARYNX, UNILATERAL (EG, FOR CERVICAL DYSTONIA, SPASMODIC TORTICOLLIS)
64617 CHEMODENERVATION OF MUSCLE(S); LARYNX, UNILATERAL, PERCUTANEOUS (EG, FOR SPASMODIC DYSPHONIA), INCLUDES GUIDANCE BY NEEDLE ELECTROMYOGRAPHY, WHEN PERFORMED
64640 DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH
64642 CHEMODENERVATION OF ONE EXTREMITY; 1-4 MUSCLE(S)
64643 CHEMODENERVATION OF ONE EXTREMITY; EACH ADDITIONAL EXTREMITY, 1-4 MUSCLE(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
64644 CHEMODENERVATION OF ONE EXTREMITY; 5 OR MORE MUSCLES
64645 CHEMODENERVATION OF ONE EXTREMITY; EACH ADDITIONAL EXTREMITY, 5 OR MORE MUSCLES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
64646 CHEMODENERVATION OF TRUNK MUSCLE(S); 1-5 MUSCLE(S)
64647 CHEMODENERVATION OF TRUNK MUSCLE(S); 6 OR MORE MUSCLES

HCPCS Pain Management Billing Codes for Botox and Chemodenervation
J0585 INJECTION, ONABOTULINUMTOXINA, 1 UNIT
J0586 INJECTION, ABOBOTULINUMTOXINA, 5 UNITS
J0587 INJECTION, RIMABOTULINUMTOXINB, 100 UNITS
J0588 INJECTION, INCOBOTULINUMTOXIN A, 1 UNIT

​What is CPT Code 64451? This is for the Block

64451, Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or CT computed tomography), should be reported once for this procedure. The fluoroscopic guidance should not be separately reported as it is included in the work described with code 64451.

• Unilateral (Modifier LT, RT and 50 for Bilateral)
• Imaging is inclusive
• Do not report in conjuction with 64493, 64494, 64495, 77002, 77003, 77012, 95873, 95874
• When performed under Ultrasound, use CPT Code 76999 instead of 64451