64633-64636 billable units

We are having a little bit of a debate on these codes and how many units can be billed on the secondary code. We are wanting to bill these out correctly. Information we have recd can be confusing. So I am throwing this out there for other coders opinions. On the sample documentation below. We coded 64633x1 and 64634x1 but the debate is it should be 64633x1 and 64634x2. So if t5-T6, T6-T7, and T7-T8 is injected I am seeing this as 64633x1 64634x2. This is how I see it but I can also see it coded the other way too. Can be so confusing! Please help us to go in the right direction.

Pre/Post Procedure Diagnosis:

1. Thoracic Spondylosis

2. Thoracic Intervertebral Disc Disease

3. Thoracic Facet Mediated Pain

4. Chronic Mid Back Pain

Procedure:

1. left T5, T6, T7 and T8 Radio-Frequency Ablation (RFA)

2. Fluoroscopic Needle Localization

Procedure Summary:

The risks and benefits of the procedure were discussed with the patient who agreed to proceed via written consent. The patient was escorted to the fluoroscopy suite and placed in the prone position on the procedure room table. The thoracic region was cleaned with chlorhexidine x 3 then draped in the usual sterile fashion. A time out was performed to confirm this was the correct patient, procedure, and location. All pressure points were checked, padded, and verbal communication was maintained with the patient throughout the procedure.

AP fluoroscopy was used to identify the T5, T6, T7 and T8 vertebral bodies. The image was optimized to visualize the junctions of the _left_ superior articular processes with the transverse processes at the target levels.

The skin and subcutaneous tissue inferior to those junctions was anesthetized with 1% lidocaine. A 20-gauge RF Stryker needle was then advanced percutaneously through the anesthetized skin tracts under fluoroscopic guidance until the non-insulated portion of the needles lie at the junctions of the above mentioned superior articular processes and transverse processes. All needle tips were confirmed to be posterior to the neural foramen in the lateral fluoroscopic view. Motor stimulation was performed up to 1.5V at each level producing stimulation of the multifidus muscles of the back and no stimulation of the lower extremity at any level. Each level was then anesthetized with 1% lidocaine prior to treatment with pulsed radiofrequency thermocoagulation for 120 seconds at 42 degrees Celsius. Each level was then treated with thermal radiofrequency thermocoagulation at 60 degrees Celsius for 90 seconds. Prior to the removal of each needle, a volume of 1 mL consisting of 10 mg of triamcinolone mixed with 1 mL 0.25% bupivacaine was injected at each site. The needles were flushed and removed and band-aids were applied over the needle puncture sites.

The patient tolerated the procedure well and and there were no complications. After being monitored post-procedure, the patient was discharged to home in stable condition without any new neurologic deficit.

64633-64636 billable units