Neurology & Pain Management Coding Alert

Count levels treated, not injections, for 64470-64476 Coding for facet injections is fairly easy, as long as you count things correctly -- and count the correct part of the procedure. When coding some injection procedures, you count the number of injections your physician administers. But you code facet injections based on the levels he treats. You should report only a single unit of service for multiple injections at the same spinal level-- unless your neurologist provides the injections bilaterally. Simply append modifier 50 (Bilateral procedure) for bilateral injections, but be careful to not exceed your carrier's utilization guidelines. Here are five easy ways to keep your facet injection coding on track. Choose 64472 and 64476 for Additional Levels When reporting facet joint injections, you should choose either 64470 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level) or 64475 (... lumbar or sacral, single level), depending on the spinal area the neurologist treats. For each additional level the neurologist injects in the cervical or thoracic area, report +64472 (... cervical or thoracic, each additional level [list separately in addition to code for primary procedure]). For each additional level the neurologist injects in the lumbar or sacral area, turn instead to +64476 (... lumbar or sacral, each additional level [list separately in addition to code for primary procedure]). Although the descriptors for codes 64470-64476 specify spinal -levels,- your neurologist actually targets facet joint injections at the space between vertebrae (in other words, the interspace), not at the vertebrae themselves, says Susan Allen, CPC, CCS-P, coding manager and compliance officer for Florida Spine Institute in Clearwater. If the neurologist documents, for instance, -Facet joint injection at C4-C5,- this represents a single injection to the interspace between the forth and fifth cervical vertebrae, not two separate injections at the fourth and fifth cervical vertebrae. Example: Your neurologist provides facet joint injections at L1-L2 and L2-L3. In this case, you would report 64475 (for the initial lumbar level) and 64476 (for the injection at the additional lumbar level). Same-Level, Same-Side Injections = 1 -Unit-

If the neurologist provides more than one injection at the same spinal level and on the same side of the spine, you may report only a single unit of service for most payers, says Trish Bukauskas-Vollmer, CPC, owner of TB Consulting in Myrtle Beach, S.C. Example: The neurologist must administer two injections to block the median branch nerve inside the joint because one branch of the nerve sits at the top of the facet joint and a second branch sits at the bottom. Some coders mistakenly believe that because the neurologist must administer two injections, they may bill for two separate injections. This [...]