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Radiology Coding Alert

Take 'Bilateral' at Face Value for 64470 or Face CMS Scrutiny

Published on Fri Nov 11, 2011

OIG and Medicare both want you to get your modifier 50 ducks in a row. Facet joint injection coding foul-ups -- resulting in $96 million in improper payments -- prompted a recent CMS clarification on proper modifier 50 use. Here's what you need to know to keep your claims in the clear. The gist: A recent OIG report on 2006 services found that doctors incorrectly assigned facet joint add-on codes to report bilateral injections. CMS released MLN Matters article MM6518 (effective date August 31) to explain how to code these procedures properly. Both the OIG and CMS focus on these codes: • 64470 -- Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level • +64472 -- ... cervical or thoracic, each additional level (List separately in addition to code for primary procedure) • 64475 -- ... lumbar or sacral, single level • +64476 -- ... lumbar or sacral, [...]
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