If you work in pain management, anesthesia or interventional radiology, you are probably keenly aware of the changes that have occurred over the past three years with facet joint injection coding and its effect on your bottom line.
A facet joint injection is a diagnostic procedure used to determine if the patient's spine pain is related to arthropathy of the facet joints. During a facet joint block, an anesthetic is injected into the facet joints where the associated spinal nerves travel to see if it will stop or 'block' the pain. Sometimes a steroid is injected with the anesthetic to help with the inflammation.
If the results of the injection prove positive the patient qualifies for a therapeutic procedure called radiofrequency (RF) ablation. (RF) ablation temporarily destroys the affected spinal nerves thereby blocking the pain on a more long-term basis anywhere from six months to a year.
Many patients have back pain which makes this procedure beneficial for many and at the same time ripe for overuse. As such, Medicare has reviewed and researched the effects of this procedure and listed a set of criteria that must be met in order to perform the diagnostic testing and RF ablation. This criteria can be found on the Medicare website.
Payment for services rendered depends on the documentation meeting the criteria put forth by Medicare, so work smartly and efficiently by reviewing the Medicare LCD and make sure your providers are aware of the criteria that must be documented in the patient's record. Let's review the main issues surrounding coding this procedure.
Understanding spinal anatomy is the second step to ensuring reimbursement through correct coding. Most coders under or over code facet blocks because of the odd number of nerves to vertebra that occur in the cervical spine. Let's take a moment and review the spinal anatomy you'll need to know for correct code selection.
As a coder, make sure you thoroughly understand the nerves assigned to each facet joint well. Anatomy is a must for this procedure.
There are up to three CPT codes used to report facet joint injections based on spinal region. The codes allow for three levels maximum per session. Anything over three are considered free of charge, as they will not be reimbursed.
Cervical/Thoracic Facet Joints:
64490 First facet joint level
64491 Second facet joint level
64492 Third and all remaining facet joint levels (only bill once for all remaining levels 3+)
Lumbar/Sacral Facet Joints:
64493 First facet joint level
64494 Second facet joint level
64495 Third and all remaining facet joint levels (only bill once for all remaining levels 3+)
The T12-L1 facet joint is considered part of the lumbar/sacral region when coding facet joint injections.
The next major issue with coding facet joint injections correctly is understanding the documentation. There is an industry standard way to document facet joint injections. When providers do not follow industry standard documentation practices over-coding or under-coding usually occurs.
Let's review the documentation issues you may encounter and what they mean:
Physicians who are aware of this confusing issue may simply document both for clarity. Example: "Nerves C4, C5, and C6 were blocked targeting the C4-5 and C5-6 facet joints."
Let's look at some examples:
Staying up-to-date on recent changes and the standard methods of coding facet joint injection is critical to your provider's practice and your bottom line.
Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding.
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