Modifier Code for Multiple Levels of CPT 64490
For multiple levels of CPT code 64490 (injection procedure for cervical facet joint), modifier 59 should be used to indicate distinct procedural services at different levels.
Understanding CPT 64490 and Multiple Level Coding
- CPT code 64490 specifically refers to the injection procedure for cervical or thoracic facet joint at a single level 1
- When performing injections at multiple levels, the appropriate coding approach is:
- First level: 64490 (no modifier)
- Second level: 64491 with modifier 59
- Third level and beyond: 64492 with modifier 59 1
Proper Modifier Usage
- Modifier 59 is the appropriate modifier to use when documenting distinct procedural services at different spinal levels 1
- This modifier indicates that the procedure was performed at a separate and distinct anatomical site (different spinal level) 1
- Using modifier 59 properly ensures accurate reimbursement for each level treated during the procedure 1
Coding Best Practices
- Documentation should clearly specify each level treated to support the use of these codes and modifiers 1
- Avoid using modifier 95 (telemedicine modifier) as this is inappropriate for injection procedures and only applies to telehealth services 1
- Ensure that medical necessity is well-documented for each level requiring treatment to support reimbursement 1
Common Pitfalls to Avoid
- Using the same CPT code (64490) multiple times with modifiers instead of using the proper sequential codes (64491,64492) 1
- Failing to document the specific levels treated, which may result in claim denials 1
- Incorrectly applying modifiers that don't indicate distinct procedural services (such as modifier 95, which is specifically for telemedicine) 1
Billing Implications
- Proper coding with appropriate modifiers ensures accurate reimbursement for all levels treated 1
- Incorrect coding may result in bundling of procedures and reduced reimbursement 1
- Medicare and other payers typically recognize these codes with appropriate modifiers when medical necessity is established 1