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Facet joint injections

C

ccooke9956

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8
Can someone give me help on how to code the following?
bilateral C2, C4, C6 and C8 facet joint injections

Thanks so much,
Candace
 
To ensure providing you with an accurate response, please indicate the substance(s) injected.
Also, was any radiological guidance utilized? (In case in have to code that as well)
 
64470-64472 code range

In your response to Karen's request, you may also want to indicated who you code for (doctor, ASC, Hospital etc)
 
Code Range 64470-64472 is for injection of steroid and/ or an anesthetic.

If a Neurolytic is injected, code range is 64626-64627.

If any other type of substance is injected, this falls to 64999.
 
Thanks for your responses, the medication is Depo-Medrol, bilateral, multilevel. This is being billed from a physician office.
 
Is the below correct?
64475 -50 - 1 unit
64476 -50 - 1 unit
64476 -50 - 1 unit
64476 -50 - 1 unit
J3301

Thanks for any and all feedback. Not sure if I should bill one unit vs two units.
 
Facet Injections

I believe the information you recieved for the 8 facet injections in the neck was incorrect.. I bill facet injections all the time and have no problem w/ recieving payment. CPT codes 64475 & 64476 are for facet injections to the lumbar spine, and the facet injections your Dr gave was to the C/S. The correct way to code this is:
64470 RT
64470 LT
64472 RT
64472 LT
64472 59RT
64472 59LT
64472 59RT
64472 59LT

I Normally only bill a max of 6 injections at one time, our Dr's have never given 8 at once. Also, the correct HCPCs code for depo-medrol is J1030.

I hope this helps
 
Facet Injections

I believe the information you recieved for the 8 facet injections in the neck was incorrect.. I bill facet injections all the time and have no problem w/ recieving payment. CPT codes 64475 & 64476 are for facet injections to the lumbar spine, and the facet injections your Dr gave was to the C/S. The correct way to code this is:
64470 RT
64470 LT
64472 RT
64472 LT
64472 59RT
64472 59LT
64472 59RT
64472 59LT

I Normally only bill a max of 6 injections at one time, our Dr's have never given 8 at once. Also, the correct HCPCs code for depo-medrol is J1030.

I hope this helps
 
cdecristofaro said:
I believe the information you recieved for the 8 facet injections in the neck was incorrect.. I bill facet injections all the time and have no problem w/ recieving payment. CPT codes 64475 & 64476 are for facet injections to the lumbar spine, and the facet injections your Dr gave was to the C/S. The correct way to code this is:
64470 RT
64470 LT
64472 RT
64472 LT
64472 59RT
64472 59LT
64472 59RT
64472 59LT

I Normally only bill a max of 6 injections at one time, our Dr's have never given 8 at once. Also, the correct HCPCs code for depo-medrol is J1030.

I hope this helps
Click to expand...

Based on all of the recent controversy regarding payment issues with the facet injections and the OIG coming down on practices that are doing this incorrectly, I would have to disagree with breaking them out per line item (unless you code for an ASC and its a Medicare patient since those are different guidelines)

Please see these links:

http://www.justmypassion.com/articles-MBC-09.html

http://www.oig.hhs.gov/oei/reports/oei-05-07-00200.pdf

https://www.aapc.com/news/index.php/2008/09/watch-how-you-code-for-facet-joint-injections/
 
Last edited:
cdecristofaro - If this is how you have been billing your bilateral facet injections then you have likely been receiving incorrect payments. In addition to the links Mary posted, the Orthopedic Coder's Pink Sheet had a great article in October that broke down how to correctly bill these injections and also showed how billing them incorrectly resulted in overpayment. By splitting your injection codes on two lines using RT & LT you are not receiving the bilateral fee reduction.
 
Actually, I code facet joint injections on a regular basis as well.
I do Ambulatory Surgery coding for a hospital, and don't have to code the "J" codes for injected substances because they are assigned via Chargemaster.

However, the code ranges I provided above for the "Cervical" Facet injections are correct.
Also, I don't think you should be using a "59" modifier, because these case can be billed with a "50".
 
Billing for Facet Joint Injections

So is billing done according to how many injections were actually done, or is it by level?
Example- Bilateral injections done at L4-L5. Would it be correct to say:
64475 x 2 (LT AND RT)
77003 (Flouro)
 
knevans said:
So is billing done according to how many injections were actually done, or is it by level?
Example- Bilateral injections done at L4-L5. Would it be correct to say:
64475 x 2 (LT AND RT)
77003 (Flouro)
Click to expand...

Per the September 2004 CPT Assistant, it states:
only one facet injection code should be reported at a specified level and side injected (eg, right L4-L5 facet joint) regardless of the number of needles inserted or number of drugs injected at that specific level.
Hope that helps!
 
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