Billing and coding is not as easy as one might think. The rules are constantly changing—and the codes for facet joint injections, which have changed frequently over the years, are a prime example. To make sure your practice is in compliance, billers, coders, and physicians should remain informed of the correct coding guidelines for facet joint injections. No one in a physician’s practice should ever assume that, because they coded a procedure a certain way in years past, it is still the status quo. Every rheumatologist and his or her staff should understand the what, why, and where of facet joint injections.
What Are Facet Joint Injections and Are They Helpful?
Facet joint injections are diagnostic and treatment injections done by filling the facet joint with an anesthetic medication that numbs the facet joint as well as the ligament joint capsule around it.
If the facet joints become painful due to arthritis, injury, or mechanical stress, they can cause pain in various areas. The lumbar, cervical, and thoracic facet joints can cause pain in the back, hip, buttock, or leg. Placing medication into the joint through the injection should relieve any pain that a patient is experiencing, as well as assist in confirming or denying the joint as the source of pain. If a patient obtains complete relief of the pain while the facet joints are numb, it is likely these joints are the pain source. Furthermore, time-release cortisone can be injected into these joints to reduce any presumed inflammation, which can, on many occasions, provide long-term pain relief.
2010 Code Changes
According to the American Medical Association (AMA), the 2010 version of the Current Procedural Terminology organized the facet joint injections codes by deleting the code series 64470–64476 and using the 64490–64495 series in its place.
Currently, the facet joint injections procedural codes are located in the nervous system section of the CPT manual. The six codes are:
- 64490 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic, single level
- +64491 Second level (list separately in addition to code for primary procedure)
- +64492 Third and any additional level(s) (list separately in addition to code for primary procedure)
- 64493 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level
- +64494 Second level (list separately in addition to code for primary procedure)
- +64495 Third and any additional level(s) (list separately in addition to code for primary procedure)
The AMA has stated that the new descriptor for facet joint codes is a shift to prepare for ICD-10. As we near the date of ICD-10 implementation, communication and partnership between physicians and coders is going to be crucial, in order to deal with the increasing level of specificity.
Every rheumatology practice should have the latest CPT, ICD-9, and HCPSC books in the office to make sure everyone is up to date with all code changes and to make sure procedures aren’t coded incorrectly. In addition, all super bills and charge slips should be updated to reflect the new codes in order to avoid unnecessary denials or delays in reimbursement.
Image Guidance
Whether using fluoroscopy or computed axial tomography, guidance is required to code for this procedure. If ultrasound guidance is used for the above procedures, the 2010 CPT guide states that you must report the facet joint injection as 64999. If no image is used for the procedures, you must report it as an injection code using the CPT codes 20550–20553.
Coders should note that the biggest change in the 2010 facet joint codes is that it is no longer allowable to bill separately for the image guidance.
One key point for rheumatology practices is that facet joint injections have been targeted by the Office of Inspector General as a procedure with a high error rate and are on their watch list. Also, the Centers for Medicare and Medicaid Services (CMS) released two transmittals last year on the subject of facet joints—Transmittal 526 (Change Request 6518) and Transmittal 440 (CR6317). These are available on the CMS Web site at www.cms.hhs.gov/transmittals.
It is important to stay abreast of coding guideline changes because there will be more focused audits by carriers on facet joint procedures in the coming months. If you have any questions about coding or billing in your practice, contact Melesia Tillman, CPC, CRHC, at (404) 633-3777 or at [email protected].
