Coding Pain Management

Transforaminal epidural injection: 64479-64484
Transforaminal epidural injection is given at the nerve root in to the spidural space(64479-64484). The injection is passed through the foramen to reach the nerve root. These are unilateral codes and require 50 modifier for bilateral injections. The physician injects at the nerve root like L4 or between the vertebral interspaces like L4-L5.

Interlaminar injections: 62310-62311
Interlaminar injections are given in to epidiral or subarahnoid space through lamina without passing through the foramin. The injection goes directly into the lamina unlike previous one which has to go through foramen and then lamina. These are nonneurolytic injections for dianostic or therapeutic purposes inlcuding anesthetic, steroid, opoid or other substances. These injections also includes contrast if given.

Facet jont injections: 64422-64427
Code Range 64470-64472 is for injection of steroid and/or an anesthetic.
If any other type of substance is injected may be nondistructive or pulsed radiofrequency use 64999. Facet joint injection codes are unilateral and modifier 50 should be used for bilateral procedures. If a Neurolytic is injected for destruction, code range is 62280-62284.

Trigger point injection: 20550-20553
CPT codes 20552-20553 are reported only once per session. CPT code 20551 should be reported one time for multiple or single injections to a single tendon origin or tendon insertion performed. Injections to multiple tendon origins or tendon insertions are reported one time for each injection. For dry needling technique use unlisted procedure code 20999. Imaging guidance is reported sepertely like 77002 for fluoroscopic, 76942 for ultrasound, and 77021 for MR.