Forum - Questions & Answers

Aug 9th, 2011 - BMoe

Facet injections

Not exactly sure of how to code this, any help would be appreciated.

This is what I came up with...
64493-Bilateral for the L4-L5;
64494-Left for the L2-L4;
64495-Right for the L3-L4;


Bilateral L5 dorsal ramus nerve branch blocks under fluoroscopic guidance with radiologic interpretation.

Bilateral L4 medial nerve branch blocks under fluoroscopic guidance with radiologic interpretation.

Right L3 medial nerve branch block under fluoroscopic guidance with radiologic interpretation.

Left L2 medial nerve branch block under fluoroscopic guidance with radiologic interpretation.

Thanks!
Bonnie Moeller
Ft Wayne Neurosurgery/PMR/ASC

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Aug 9th, 2011 - jschmutz   323 

re: Facet injections

USE OF NEW FACET INJECTION CODES FOR 2010


1. Report one code per level, but you can only report up to 3 levels. When documentation reads injection at C5-C6 and C6-C7 that is two levels so report CPT® codes 64490 and 64491.However, when the documentation reads injection at C5 and C6 (medial branch blocks) that would be reported as 64490 - a single level injection, since each facet joint is innervated by two medial branch nerves. Injection of these two nerves achieves a blockade of only one facet joint, (See CPT® Assistant Sep. 04: 01)


2. CPT® code 64492 and 64495 represent third and any additional levels so you would NEVER report more than 3 facet injection codes for cervical/thoracic or 3 facet injection codes for lumbar/sacral regions.


3. Fluoroscopy or CT guidance are considered components of the CPT® code so these types of image guidance would not be additionally reported, BUT USE OF FLOUROSCOPY OR CT IS REQUIRED TO ACCOMPLISH THE PROCEDURE – SO, IF IMAGE GUIDANCE IS NOT USED YOU WOULD REPORT 20550-20553.


4. Parenthetical notes in the CPT® book are incorrect – they state if ultrasound guidance is used report 64999, THIS IS WRONG. When ultrasound guidance is used report the appropriate Category III code from the 0213T-0218T range. These codes are not listed in your CPT® book but can be found at the following link on the AMA Website.
http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/about-cpt/category-iii-codes.shtml


5. Facet Injections performed at the T12-L1 level should be reported with CPT® code 64493 LUMBAR – this differs from CPT® Assistant guidance that tells us to report 62310 (cervical/thoracic) when an epidural injection is performed at T12-L1. (Dec. 05 Special Issue Q&A)


6. Although the codes have changed you can still report bilateral procedures with modifier 50 or RT/LT as appropriate.


 


The “BELIEVE IT OR NOT” with Pain Management Coding



  1. Epidural injections are only reported one time per date of service for a given region, it would not be appropriate to append modifier 50 for a bilateral procedure nor modifier 59 for multiple levels.

  2. An epidural injection at T12-L1 is reported with the cervical epidural injection code, but a facet joint injection at T12-L1 is reported with a lumbar facet injection code.

  3. A facet injection code is reported as one level when 2 medial branch nerves are injected but destruction codes are reported for two levels when 2 medial branch nerves are destroyed.

  4. Facet injections that are performed without the use of fluoroscopy are reported with trigger point injection codes.

  5. Facet joint injections performed using ultrasound are reported with Category III codes 0213T-0218T and as of July 1, 2010 Transforaminal injections using ultrasound will be reported with Category III codes 0228T-0231T.

  6. An L3-L4 transforaminal injection is reported as one level, but injections into the L3, L4 foramen are reported as two levels.

  7. Radiofrequency nerve ablation is reported with the appropriate CPT® code, Pulsed Radiofrequency is reported with Unlisted CPT® code 64999.

  8. Destruction of lateral branch nerves S1-S4 using the Simplicity III probe is reported with Unlisted CPT® one time for each nerve. code 64999, but when each lateral branch nerve is individually destroyed CPT® code 64040 is reported.

  9. SI joint injections that are performed without the use of fluoroscopy are reported with the large joint injection code 20610.

  10. Sympathetic nerve blocks performed using fluoroscopy are reported with CPT® code 77002 rather than 77003.

 




USE OF NEW FACET INJECTION CODES FOR 2010
1. Report one code per level, but you can only report up to 3 levels. When documentation reads injection at C5-C6 and C6-C7 that is two levels so report CPT® codes 64490 and 64491.However, when the documentation reads injection at C5 and C6 (medial branch blocks) that would be reported as 64490 - a single level injection, since each facet joint is innervated by two medial branch nerves. Injection of these two nerves achieves a blockade of only one facet joint, (See CPT® Assistant Sep. 04: 01)
2. CPT® code 64492 and 64495 represent third and any additional levels so you would NEVER report more than 3 facet injection codes for cervical/thoracic or 3 facet injection codes for lumbar/sacral regions.
3. Fluoroscopy or CT guidance are considered components of the CPT® code so these types of image guidance would not be additionally reported, BUT USE OF FLOUROSCOPY OR CT IS REQUIRED TO ACCOMPLISH THE PROCEDURE – SO, IF IMAGE GUIDANCE IS NOT USED YOU WOULD REPORT 20550-20553.
4. Parenthetical notes in the CPT® book are incorrect – they state if ultrasound guidance is used report 64999, THIS IS WRONG. When ultrasound guidance is used report the appropriate Category III code from the 0213T-0218T range. These codes are not listed in your CPT® book but can be found at the following link on the AMA Website.
http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/about-cpt/category-iii-codes.shtml
5. Facet Injections performed at the T12-L1 level should be reported with CPT® code 64493 LUMBAR – this differs from CPT® Assistant guidance that tells us to report 62310 (cervical/thoracic) when an epidural injection is performed at T12-L1. (Dec. 05 Special Issue Q&A)
6. Although the codes have changed you can still report bilateral procedures with modifier 50 or RT/LT as appropriate.

The “BELIEVE IT OR NOT” with Pain Management Coding
1. Epidural injections are only reported one time per date of service for a given region, it would not be appropriate to append modifier 50 for a bilateral procedure nor modifier 59 for multiple levels.
2. An epidural injection at T12-L1 is reported with the cervical epidural injection code, but a facet joint injection at T12-L1 is reported with a lumbar facet injection code.
3. A facet injection code is reported as one level when 2 medial branch nerves are injected but destruction codes are reported for two levels when 2 medial branch nerves are destroyed.
4. Facet injections that are performed without the use of fluoroscopy are reported with trigger point injection codes.
5. Facet joint injections performed using ultrasound are reported with Category III codes 0213T-0218T and as of July 1, 2010 Transforaminal injections using ultrasound will be reported with Category III codes 0228T-0231T.
6. An L3-L4 transforaminal injection is reported as one level, but injections into the L3, L4 foramen are reported as two levels.
7. Radiofrequency nerve ablation is reported with the appropriate CPT® code, Pulsed Radiofrequency is reported with Unlisted CPT® code 64999.
8. Destruction of lateral branch nerves S1-S4 using the Simplicity III probe is reported with Unlisted CPT® one time for each nerve. code 64999, but when each lateral branch nerve is individually destroyed CPT® code 64040 is reported.
9. SI joint injections that are performed without the use of fluoroscopy are reported with the large joint injection code 20610.
10. Sympathetic nerve blocks performed using fluoroscopy are reported with CPT® code 77002 rather than 77003.

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