Neurosurgery Coding Alert

Question: One of our physicians performs facet injections without fluoroscopy in the office. The carrier denied coverage for the entire procedure, saying he must use fluoroscopy to confirm location. Have some carriers- guidelines changed? Michigan Subscriber Answer: Some carriers are changing their guidelines for facet injections, and some are moving toward requiring fluoroscopic guidance for confirmation with these procedures. Check the latest policies in your area because the carrier might deny your claim or assign a different code if your physician does not use fluoroscopy. For example, the carrier might say that if you don't have documentation of fluoroscopic guidance to prove that the physician penetrated the facet joint, you-ll have to report the service as a trigger point injection (20551, Injection[s]; single tendon origin/insertion) instead of 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) for single injections. The surgeon may choose to perform facet joint injections without fluoroscopic guidance, knowing that some providers might either devalue or deny the entire facet injection claim Or, the surgeon could use some form of radiologic needle guidance (that is, fluoroscopy) to document that he correctly placed each needle either in the facet joint or at the location of the paravertebral facet joint nerve. Your coding might change once you-ve shared the options, depending on your physician's mind-set. If he begins to use fluoroscopic guidance with the procedures, report it with 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve, or sacroiliac joint], including neurolytic agent destruction), with one unit of service per each spinal region treated.