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Q&A: Dual coding pain management with CPT and ICD-10-PCS
Q: We are coding for pain management procedures and have been doing dual coding in ICD-9-CM and CPT®. With a medial branch block ablation at two levels for L3-L4 and L4-L5 for a bilateral injection, we are coding:
- ICD-9-CM procedure code 04.2 (destruction of cranial and peripheral nerves)
- CPT codes 64635 (destruction by neurolytic agent, paravertebral facet joint nerve[s], with imaging guidance [fluoroscopy or CT]; lumbar or sacral, single facet joint) and 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]), each with modifier -50 (bilateral procedure) appended.
What would be your recommendation for the ICD-10-PCS code? Currently we are coding 015B3ZZ (destruction, lumbar nerve, percutaneous) twice. We are not sure if we should be picking this code up twice or only once.
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