Neurology & Pain Management Coding Alert

Most coders err with 64470 and 64475 -- here's how to buck the trend. The Office of Inspector General (OIG) recently released a report that should have you scrambling to double-check your claims for facet joint injections. The Sept. 17 report indicates that -63 percent of facet joint injection services allowed by Medicare in 2006 did not meet Medicare program requirements, resulting in approximately $96 million in improper payments for physician services.- Avoid becoming a statistic with these tips. Beware of Office-Based Errors The OIG report -- -Medicare Payments for Facet Joint Injection Services- -- indicates that 71 percent of facet joint injections performed in physicians- offices contained errors, while only 51 percent of facility-based facet joint injections showed errors. OIG note: The OIG report noted that more than 60 percent of the errors it found concerned -instances in which the physician billed incorrectly for bilateral facet joint injections.- For example: Physicians reported add-on codes to indicate that a contralateral side of a spinal level was injected, although they should have simply appended modifier 50 (Bilateral procedure) to the facet joint injection code. All this puts your neurologist's practice under the microscope. Here's how to dissect facet joint injections correctly and avoid the wrath of the OIG. First: Add-Ons Apply to Extra 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 your neurologist treats. For each additional level your 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 he 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]). Second: Clarify Terminology Although the descriptors for 64470 through +64476 specify spinal levels, your physician actually targets facet joint injection procedures at the space between vertebrae (in other words, the interspace), says Alexandra Cortina with Pain Billing Pros in Clearwater, Fla. For instance: If your neurologist documents -facet joint injection at C4-C5,- this represents a single injection to the joint between the fourth and fifth cervical vertebrae. However, your neurologist can alternately perform inject-ions of the two paravertebral facet joint nerves (medial branches) that provide sensory information from the single facet joint back to the spinal cord. In this situation, your neurologist performs a total of two injections -- the first at the C4 vertebrae for the C4 medial branch, and the second at the C5 vertebrae to block the C5 [...]