Wiki Help!! New facet blocks 64490-64495

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FractalMind

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Hi! new facet blocks cross to anesthesia codes 01935 & 01936 but, how do I determine if the block is "therapeutic" or "diagnostic"?? the doctors rarely document this and the most common dx's are: pain, DDD, stenosis, etc. do you think the POS has anything to do? for example one of our doctors has a pain clinic and problably his services are "therapeutic"? if you have any info. please help me,
Thanks!:D
 
Educate your doctors on documentation. The facet joint injection can be done for either reason, regardless of place of service. We're having the same issues with ours. The only other option is to obtain the operative report or call the performing physician's office for better info.
 
Thanks for the info. We have Ingenix cross coder and they do not have facets listed.

But I am still confused because Florida Medicare has a new LCD (L30570) MAC for certain interventional pain managements services. This specifically lists facet codes (64490-64495) and 01991 and 01992 for MAC.

Medicare will no longer cover MAC for these procedures unless the patient has certian co-morbidities that would require an anestheologist.

Charla
 
Charla,

I'm sorry, I'm really not familiar with the Florida carriers. The only info I can offer you is that in CPT 01991 and 01992 only state in their descriptions that they are for nerve blocks while 01935 & 01936 are for percutaneous image guided procedures on the spine and spinal cord.
 
facet blocks

choder said:
Hi! new facet blocks cross to anesthesia codes 01935 & 01936 but, how do I determine if the block is "therapeutic" or "diagnostic"?? the doctors rarely document this and the most common dx's are: pain, DDD, stenosis, etc. do you think the POS has anything to do? for example one of our doctors has a pain clinic and problably his services are "therapeutic"? if you have any info. please help me,
Thanks!:D
Click to expand...

In my 2011 crosswalk book there is not anesthesia code, states 64490 through 64495 anesthesia care not typically required. No anesthesia code listed
 
64490 Vs (01935 & 01936)

choder said:
Hi! new facet blocks cross to anesthesia codes 01935 & 01936 but, how do I determine if the block is "therapeutic" or "diagnostic"?? the doctors rarely document this and the most common dx's are: pain, DDD, stenosis, etc. do you think the POS has anything to do? for example one of our doctors has a pain clinic and problably his services are "therapeutic"? if you have any info. please help me,
Thanks!:D
Click to expand...

Does ASA cross walk support the ASA codes 01935 & 01936 against the CPT 64490?
 
actually the 01935 and 01936 are incorrect. 01991 and 01992 should be used with all epidurals, facets, etc. as these codes specifically state they are for "nerve blocks and injections" (which is what a facet injection is), and they should be used based on the position of the patient. 01935 and 01936 would only be appropriate for other percutaneous spinal procedures (i.e. discography or spinal RFA).
 
I had billed the same way as 01992 for facet injections but was then told that with the code descriptor change for 64490-64495 to include with image guidance, that the crosswalk they were referencing which I believe was the ASA, was now saying 01935/01936 for 64490-64495
 
the new descriptor does include image guidance, but rememeber when billing anesthesia you should always choose your code based on the PRIMARY procedure (i.e., the main reason they are there). in this case the primary procedure is the injection, not the fluoro, so you would choose your anesthesia code based on that. with a discography, the main purpose of the procedure is to take images and get a diagnostic impression (there may be an injection of contrast, but again that's not the primary procedure), so in that case 01935 would be appropriate. unfortunately there's an error in the ASA crosswalk, and it's causing people a lot of confusion.
 
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