Compliance: OIG Finds 63-Percent Error Rate on Facet Joint Injections -- Here's How to Avoid Problems

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This piece covers an OIG review of facet joint injection claims and the broad compliance issues it identified, with emphasis on office-based billing patterns, bilateral procedure reporting, add-on billing structure, and documentation considerations. It is aimed at coders, billers, compliance staff, and pain management practices that need to understand the type of guidance discussed in the article and evaluate whether the full article is relevant to their work.

Why This Topic Matters

Facet joint injection claims are a compliance-sensitive area, and the article highlights an OIG audit finding a high error rate in Medicare payments. Understanding the scope of the audit and the general billing topics discussed can help practices assess whether they need the full article for internal review, education, or claim auditing.

Article Sections

  1. OIG report findings

    Summarizes the audit context and the reported payment accuracy issues associated with facet joint injection services. It also distinguishes between general service settings discussed in the report.

  2. Add-Ons Apply To Extra Levels

    Discusses the general structure of reporting facet joint injection services across spinal areas and additional levels. It also touches on terminology used in the article and the documentation context for interspaces.

  3. Keep Modifier 50 at Hand

    Covers the article’s discussion of bilateral procedure reporting and the compliance problems associated with incorrect claim patterns. It also notes the documentation emphasis tied to bilateral injection scenarios.

What You Will Learn

  • The general compliance concerns raised by an OIG audit of facet joint injection billing
  • How the article frames reporting across spinal regions and additional service levels
  • Why bilateral procedure documentation is a focus in facet joint injection claims
  • What kinds of billing issues the article says were commonly identified in the audit

Who Should Read This

  • Medical coders
  • Medical billers
  • Compliance officers
  • Pain management practices
  • Physician offices
  • Revenue cycle staff

Codes Discussed

  • CPT: 64470
  • CPT: 64475
  • CPT: 64472
  • CPT: 64476
  • CPT: 50

Modifiers Discussed

  • CPT: 50

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