Anesthesia Coding Alert

3 areas will make or break your claims

With facet injections often considered the "meat and potatoes" of pain management practices, you must understand and code them correctly. Read on for tips on the three areas you can't afford to overlook when coding these injection services and for the rules of the road for submitting these claims to different carriers. Start With the Right Codes Each vertebra is associated with four facet joints - one pair that faces upward and one pair that faces downward. The facets interlock with the adjoining vertebrae and provide spinal stability. Facet injections  target either the nerves running above and below the facet joints or the joint itself.

Code selection begins by knowing what the physician injects. Here are the four CPT codes that represent facet injections when he injects an anesthetic or steroid:
  64470 - Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level (10 relative value units [RVUs])
  +64472 - ... cervical or thoracic, each additional level (list separately in addition to code for primary procedure) (5 RVUs)
  64475 - ... lumbar or sacral, single level (8 RVUs)
  +64476 - ... lumbar or sacral, each additional level (list separately in addition to code for primary procedure) (4 RVUs). You have four additional codes to select from when the physician performs neurolysis of the facet level:
  64622 - Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level (12 RVUs)
  +64623 - ... lumbar or sacral, each additional level (list separately in addition to code for primary procedure) (6 RVUs)
  64626 - ... cervical or thoracic, single level (12 RVUs)
  +64627 - ... cervical or thoracic, each additional level (list separately in addition to code for primary procedure) (6 RVUs). Count them: When you code for facet injections, bill for the number of levels injected, says Trish Bukauskas-Vollmer, CPC, owner of TB Consulting in Myrtle Beach, S.C.

For example, an anesthetic or steroid injection to the L3/L4 and L4/L5 joints equals two levels. Report the procedure with 64475-64476 (report 64622-64623 for a neurolytic injection).

Caution: Coding can be tricky when the procedure involves both thoracic and lumbar vertebrae, such as a T12/L1 injection. Opinions on how to code this procedure vary. Check the documentation and talk with the physician if you have questions, but Bukauskas-Vollmer says you would probably code it by the thoracic level (64470 or 64626). The patient's diagnosis - whether the physician is treating thoracic or lumbar pain - [...]