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Basics of CPT code 64483 and 64484

Proper CPT coding of pain management services requires a strong understanding of the anatomy and physiology of the nervous system, including the musculoskeletal layout of the spine.

The spinal cord is divided into levels according to the nerve roots that branch off the spinal cord.

Spinal stenosis, or a narrowing of the disk space between spinal levels, can cause inflammation of the nerve roots.

When this happens, common forms of treatment for the resulting lower back pain are epidural steroid injections (ESI), which provide pain relief that lasts anywhere from a week to a year.

Two commonly delivered epidural modalities include translaminar, or interlaminar ESIs, and transforaminal ESIs.

Translaminar ESIs are delivered through the back of the spine in the space between two vertebrae and deliver steroids over a wide area, according to Simmons. The purpose of the translaminar ESI is to relieve cervical (neck pain), thoracic (mid-back pain), or lumbar (low pain).

The commonly delivered epidural modality— the transforaminal ESI—is referred to as a “nerve block” and used to treat pain caused by inflamed or irritated spinal nerves. This type of epidural injection is delivered into the spinal foramen, or the opening on the side of the spine where the nerve root exits the spinal cord, allowing for a concentrated delivery to a nerve, according to the NASS.

A transforaminal epidural steroid injection is used to treat pain caused by inflamed and irritated spinal nerves. There are two types of transforaminal ESIs: single level injections, which target nerve roots that lie across one level of the spine, and multilevel, which target two levels of the spine causing pain.

When to use CPT code 64483 and 64484

In this exam, the physician injects an anesthetic agent and/or a long-acting corticosteroid into the epidural space using a transforaminal approach. The patient, who is sedated but awake through the intervention, is placed prone on the procedure table and the injection site sterilized with iodine or chlorhexidine. A small-gauge blunt needle is inserted through the skin and into the epidural space through the bony opening of the exiting nerve root. This approach is used primarily in the treatment of herniated discs and foraminal stenosis and requires imaging guidance by fluoroscopy or CT. The injection may be performed on one or more levels.

CPT code 64479 is reported for a single cervical or thoracic level (including the T12-L1 level) and 64480 for each additional level. CPT code 64483 is reported for a single lumbar or sacral level and 64484 for each additional level.

The following CPT codes description used to report transforaminal ESIs, based on the spinal level treated and the number of injections administered:

64479, injection, anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance, cervical or thoracic, single level
Add-on code 64480, injection, anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance, cervical or thoracic, each additional level
64483, injection, anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance, lumbar or sacral, single level
Add-on code 64484, injection, anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance, lumbar or sacral, each additional level

Codes 64479, 64480, 64483, and 64484 describe unilateral procedures. When the services are performed bilaterally, report the primary codes 64479 and 64483 with modifier 50 appended. Report the add-on codes 64480 and 64484 twice, when performed bilaterally, but do not append modifier 50.

Add-on codes are always performed in addition to the primary service or procedure and must never be reported as a stand-alone code. When the add-on procedure can be reported bilaterally and is performed bilaterally, the appropriate add-on code is reported twice, unless the code descriptor, guidelines, or parenthetical instructions for that particular add-on code instructs otherwise. Do not report modifier 50, Bilateral Procedures, in conjunction with add-on codes.

For transforaminal epidural injection at the T12-L1 level, report code 64479.