Facet Joint Injection - We have a rheumatologist

mwarmke

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We have a rheumatologist who does facet joint injections using ultrasound
guidance not ct or fluoro. I know this is a catagory III code which isn't getting
paid. Does anyone have a solution for us? Could we use the 64490 to 64492 and reduce
the fee legally?
thanks marsha
 

OCD_coder

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You would most definitely use the Facet Injections 64490-64495 code family on the 1st line. Depending on the level(s) you are doing. Reducing the fee is inappropriate as the physician is donig the work.

But for the ultrasound, on line #2, use the 0213T-0218T depending on what was done. If insurance doesn't pay - write it off. The Category III codes need to be used so that the industry can track how often it is used so that a permanent code will be developed by the AMA.

I hope that makes sense.
 

mmorningstarcpc

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In addition to the previous response, per CPT guidelines, if a Category III code exists, you must use that code, and not an unlisted code (or other code for payment). You may want to tell the patient this procedure will not be paid and get an ABN.

Best,
 

mitchellde

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You would most definitely use the Facet Injections 64490-64495 code family on the 1st line. Depending on the level(s) you are doing. Reducing the fee is inappropriate as the physician is donig the work.

But for the ultrasound, on line #2, use the 0213T-0218T depending on what was done. If insurance doesn't pay - write it off. The Category III codes need to be used so that the industry can track how often it is used so that a permanent code will be developed by the AMA.

I hope that makes sense.
You would never bill both for one injection, the 0213T-0218T code is the injection with the ultrasound guidance and the 64490-64495 is the injection with fluro or CT guidance. So if you billed them as you suggested then you are billing for 2 injections each with a different guidance system. If the payer does not pay for the T code than you need to appeal with the notes. T codes indicate new techniques and technologies, these were created for use in July of 2010 so they are still fairly new, but you cannot use a different code for payment. You will need to explain to the patient that it may not be payable and get the waiver or appeal to the payer. What are the reasons for denial?
 

browncpc

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lumbar/sacral facet joint injection codes (64493, 64494 and 64495) are reported once when the injection procedure.
Only one facet injection code should be reported at a specific level and side injected (e.g., right L4-5 facet joint), regardless of the number of needle(s) inserted or number of drug(s) injected at that specific level.
 
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