Count every level and also check for your payers' first
choices.
While reporting facet joint injections, ensure that you
already know the spinal levels that the pain management specialist treated as
well as what your payers' first choices are for the maximum number and
frequency of the injections that can be presented. Whether the facet injections
are diagnostic or they are therapeutic, you must count each level and/or both
sides. Read on for further advice on how you must report these common
procedures and what codes for CPT you should use.
Don't Let Intent Throw You
You'll find that the terms 'diagnostic' and 'therapeutic'
are already in facet joint injection codes for CPT descriptors, as follows, but
don't be too overzealous about those descriptors:
64490 (Injection[s], diagnostic or therapeutic agent,
paravertebral facet [zygapophyseal] joint [or nerves innervating that joint]
including image guidance [fluoroscopy or CT], cervical or thoracic; single
level)
64493 (Injection[s], diagnostic or therapeutic agent,
paravertebral facet [zygapophyseal] joint [or nerves innervating that joint]
including image guidance [fluoroscopy or CT], lumbar or sacral; single level).
The purpose why the injection was given is not significant
while billing the procedure. You report the same codes for CPT regardless of
the fact whether the injection was given for diagnosis or therapy.
Reckon Each Level and Side
You must count every spinal level the pain management
physician treats. You report 64490 while the physician is injecting at the
cervical or thoracic level and then 64493 when the injection includes the
lumbar or sacral level. You do not distinctly code for several injections at
the same spinal level.
Tip: Append modifier 50 (Bilateral procedure) when the
injections are given bilaterally. You should count two units for bilateral injections
at a level. Few carriers require it 64490-50; on the other hands, other
carriers want 2 line items 64490 on the first line 64490-50 on the second. You
do not normally bill bilateral injections as 2 units. Rather, you would bill
them as either the single line item along with modifier 50 and 1 unit of
service or 2 line items -- 1 line item including modifier RT and 1 unit of
service AND 1 line item with modifier LT and 1 unit of service.
For coding purposes, a par vertebral facet (zygapophyseal) joint
level is the joint and the two medial nerve branches that originate from two
different spinal segments. The injection coding is the similar unrelatedly in
case the physician injected intra-articularly into the facet joint itself or
injected the two medial nerve branches.
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