Perform a self-audit on your facet billing

Why This Topic Matters

Facet joint injection claims have been under continued review, so incomplete documentation, weak support for medical necessity, or inconsistent modifier use can create audit exposure and payment problems. The article helps readers understand the broad compliance areas that payers and contractors are watching and why internal reviews matter.

Article Sections

1. Audit background and payer scrutiny

   Introduces the renewed attention on facet joint injection claims and summarizes the role of Medicare oversight and contractor review. It frames the article as an internal audit guide for practices handling these services.

2. Documentation and medical necessity

   Covers the broad documentation and medical necessity areas identified in claim review. It emphasizes the need to review carrier coverage policies and related diagnostic support requirements.

3. Bilateral injections and modifier use

   Discusses bilateral reporting considerations for facet procedures and the modifiers referenced by payer policy. It also notes the importance of following payer-specific billing guidance and retaining written confirmation.

4. Coding levels vs. sides

   Explains the distinction between level-based reporting and side-based reporting in the context of facet injections. This section includes an example showing how payer payment can vary depending on the reporting approach.