Correct Coding of Facet Joint Injections

on Wednesday, 19 August 2009. All News Items

On July 31, 2009, CMS released Transmittal 526 (CR 6518) concerning the correct coding of facet joint injections, especially relating to bilateral injections.  Please see the following excerpts from the MLN Matters Article .

“The primary codes, 64470 and 64475, are used for a single injection in the cervical/thoracic or lumbar/sacral area of the spine, respectively. Each primary code has an associated add-on code for use when injections are provided at multiple spinal levels. The add-on codes are 64472 (cervical/thoracic) and 64476 (lumbar/sacral).

Bilateral injections are performed on the right and left sides of one joint level. The Centers for Medicare & Medicaid Services (CMS) requires physicians to indicate a bilateral injection by using billing modifier 50 and the appropriate CPT code. If a physician performs multiple bilateral injections, modifier 50 should accompany each facet joint injection CPT code.

To summarize, when facet joint injections are performed on both the right and left sides of a level of the spine, physicians must use modifier 50 and the appropriate primary CPT code. When facet joint injections are performed at more than one level, physicians must use add-on codes 64472 or 64476 to represent additional levels of the spine injected.”

This is the fourth in a series of information from government entities concerning the coding and billing of facet joint injections.  Previous information includes: an OIG report that found errors in the billing of facet joint injections; a CMS transmittal that instructed Medicare contractors to strengthen program safeguards to prevent improper payments for facet joint injections; and Cahaba GBA probe review findings that reported issues with missing modifiers and incomplete documentation.  Although some of these articles stress physician billing and coding practices, hospitals should also take necessary actions to ensure they are documenting, coding and billing these services appropriately.

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