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Coding for facet injection

  1. Default Coding for facet injection
    Medical Coding Books
    I need help in coding for the third level of a facet injection. The dr injected levels T10-T11, T11-T12, and T12-L1. I know the first two codes would be 64490 and 64491 but am unsure of the third level. The CPT introduction states to use 64493 for level T12-L1. But would this be true in this case?
    Thanks.

  2. #2
    Default
    Per Pain Management Coding and Billing Answer Book:

    The physician often must inject above and below the nerve to treat the nerve branch. You might be tempted to bill for each injection but the correct method is to bill only for the level of the nerve branch you are treating.

    I would establish the above first, then I would definitely use 64493 as the third injection.

  3. Default
    Thanks. I just wanted to be sure I was coding this correctly.

  4. #4
    Location
    St. Joseph County, Indiana
    Posts
    101
    Default
    ...an important point to remember: If the physician injected a fourth or fifth level, there is no additional codes. The 64493 is for the third level...and every level after that.

  5. Default
    64492 is for the third and add'l levels, cervical or thoracic.
    64493 is for single level, lumbar or sacral.

  6. Default Intravenous conscious sedation
    Hi,
    Just wondering, we've been billing the iv conscious sedation, 99144, along w/our facet joint injections (64493-64495). We've been getting denials......has anyone else have this problem?

  7. #7
    Default
    Moderate Sedation is not normally required for facet joint injections, so I would bet that your denials are based in medical necessity issues.
    Walker Bachman, CPC, CPPM

  8. #8
    Default moderate sedation with facets
    We bill moderate sedation with facets without issue, other than a couple workers comp carriers that have decided that this is inclusive. I know we get paid for it from the major carriers. Just make sure you have all the "points" documented for it. We have our docs document who the trained observer is, what they are monitoring, how long the procedure lasted, which drugs were given and the amounts in the dictation so that in case it needs to go to review, we have all the right information to uphold the 99144.

    Kellie

  9. Default
    We have been getting paid for CS with Facet joints as well. It really depends on the carrier. We have Tricare and two BCBS carriers who do not cover it. Medicare does cover it, and we have not had any issues getting WC to pay it in our states. As Nienajadly said above, document who observed, the medication, how much, and how long... it's very important to have this information in the record.

  10. #10
    Location
    Jacksonville, FL
    Posts
    63
    Default
    [QUOTE=vanessa10;91539]Per Pain Management Coding and Billing Answer Book:


    Is this the actual name of the book? I would LOVE to have a book that helps with these types of questions. Tried "Googling" it but can't figure out who the book is by.

    Thanks!!
    Becki, CPC, CPMA, CGIC, CHONC, COSC, CPCD, Fellow

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