Interventional radiology is an area ripe with opportunities for coding errors, with as much as 30 percent being coded inaccurately, according to experts. Chronic pain is a significant health issue in the United States, with more than one in five adults having experienced chronic pain. This issue is even more prevalent within the Medicare population, with 65 percent of adults over the age of sixty-five impacted by chronic pain. Globally, chronic pain is the number one cause of disability and disease. One area of pain management targeted by our experts for review is facet joint injections and the services encompassed in this area. In this section, we analyze some of the vital information necessary for success in this field.
The Facet Joint: An Overview
Facet joints are an essential part of the spinal structure. They connect each vertebra to the ones above and below, enabling movement of the spine. Between each pair of vertebrae, you’ll find two facet joints, one on each side of the spine. These facet joints consist of small, bony knobs that align along the back of the spine, forming a joint that connects the two neighboring vertebrae.
Pain and Inflammation:
As we age or experience injuries, the bones within the facet joint can deteriorate, leading to a situation where they rub together instead of moving smoothly. This friction can result in pain and inflammation. To alleviate these symptoms, medical professionals may recommend injections of steroids and/or anesthetics into the facet joint or the nerves that supply the facet joints.
As noted in their descriptions, these codes are assigned for injections into the facet joint itself, or to block the nerves that innervate the facet joints. Your doctor may describe a “medial branch block.” Since the medial branch nerves go to the facet joints, this would be coded as a facet joint block. These codes are assigned per facet joint, not per vertebra or per nerve. Each facet joint is innervated by nerves from two levels, one at the same level and one above. For instance, the L4-L5 facet joint is innervated by the L3 and L4 medial branch nerves. Clarify with the physician if documentation indicates specific nerves and not facet joints.
When the procedure is performed on the left side at one level and the right side at a different level in the same region, report one unit of the primary procedure and one unit of the add-on code. When the procedure is performed bilaterally at one level and unilaterally at a different level(s), report one unit of the primary procedure for each level and append modifier 50 for the bilateral procedure. If the procedure is performed unilaterally at different levels, report one unit of the primary procedure and the appropriate add-on code(s).
Codes 64490–64495 are assigned when facet joint injections are performed under fluoroscopic or CT guidance. Do not also code 77003 or 77012.
If facet joint injections are performed under ultrasound guidance, code 0213T–0218T instead of 64490–64495. Codes 64490–64495 and 0213T–0218T are unilateral. Should bilateral injections be performed, report primary codes (0213T, 0216T) once with modifier 50. Understand that if additional level injections are performed bilaterally, report the add-on codes twice, not once with modifier 50.
A maximum of three codes may be assigned for any spinal region. Depending on type of guidance, codes 64490 / 0213T (cervical or thoracic) and 64493 / 0216T (lumbar or sacral) are assigned if a single level is injected, or for the first of multiple injections in that spinal region.
As service volumes rebound and every dollar of reimbursement counts more than ever, it’s imperative to make sure your CPT® coding is correct and compliant. Master more IR coding pain management topics and break down the complexity with our expert-infused 2023 Pain Management Interventional Radiology Coding webcast on demand. This webcast is an essential training tool for both audio and visual learners.
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