Orthopedic Coding Alert

Question: My physician is hoping to start using the new paravertebral facet joint injection codes. Are there any edits we should be aware of?

South Dakota Subscriber

Answer: Paravertebral facet joint injection codes 0213T-0218T come into play as part of mutually exclusive edits in the Correct Coding Initiative (CCI) version 16.3, which went into effect Oct. 1. CCI 16.3 pairs each of the new category III codes using ultrasound for guidance with the corresponding paravertebral facet joint injection codes using fluoroscopy or CT guidance.

This implies that you should report only a single code for performance of a diagnostic or therapeutic injection using a particular guidance method, whether it is ultrasound or fluoroscopy/CT, experts say. If methods of imagelocalization are combined, report only the more definitive method used.

The edits include:

• 64490-64492 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic ...) and
• 64493-64495 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral ...).

Each edit carries a "0" modifier indicator, so you can't use modifier 59 to override the bundling.

CCI 16.3 includes more than 16,800 edits. Check the latest version at www.cms.gov to ensure you correctly report procedures.