# Coding for facet injection



## lmcmillan (Jan 18, 2010)

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.


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## vanessa10 (Jan 18, 2010)

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.


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## lmcmillan (Jan 19, 2010)

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


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## brockorama01 (Jan 19, 2010)

...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.


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## lmcmillan (Jan 20, 2010)

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


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## hanoz420@hotmail.com (Feb 18, 2010)

*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?


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## Walker22 (Feb 18, 2010)

Moderate Sedation is not normally required for facet joint injections, so I would bet that your denials are based in medical necessity issues.


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## NIENAJADLY (Feb 19, 2010)

*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


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## hgolfos (Feb 19, 2010)

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.


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## CoderinJax (Mar 11, 2010)

vanessa10 said:


> 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.
> ...


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## hgolfos (Mar 11, 2010)

That resource is now an online publication you can subscribe to.  Here's the link: http://www.anesthesiapainanswers.com/Default.aspx

It is published by Decision Health


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## CoderinJax (Mar 11, 2010)

TY hgolfos for the link!
Now I need something else. I'm not that great at coding pain management and need some insight if I'm correct in my thinking on the below Op Report:

*Procedure performed:*
Lumbar radiofrequency denervation L2-L3, L3-L4,
L4-L5, and L5-S] bilateral, sacroiliac joint
radiofrequency denervation x4 bilateral.


*DESCRIPTION OF PROCEDURE*: 
The patient was identified as Bob the Builder and was brought to the operating suite. After placing appropriate monitoring devices and intravenous lines, monitored anesthesia care was induced. The patient was placed in prone position on the operating table. Care was taken to make sure all bony prominences had gentle pressure. Care was taken to make sure the brachial plexus had normal pressure. The neck was carefully flexed in all planes. The patient was then prepped and draped in the usual sterile manner in the lumbar field. Under fluorometric guidance, the L1-L2 facet joint was localized and injected with 0.5 cc of 0.5% Marcaine and then heated to 80”C for 90 seconds. This was done at L2-L3, L3-L,4, L4-L5, and L5-Sl first on the right and left and then was done at the sacroiliac joint in four locations first on the right and then on the left.

*What would this be coded as effective 01/01/2010? *
Here's my guess:
64493 w/ 50= 2 total
64494 w/ 50= 2 total
64495 w/ 50= 2 total

Can anyone help me please?? Thanks SO much!


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## hgolfos (Mar 11, 2010)

Yes the facet joints are coded correctly, but you have also got SI nerve destruction as well, and as far as I know there is some indecision as to how to code those.  Some sources direct 64640 x the number of nerves and others 64999.  Your best bet on that one is to try and find out what your carrier's policy is.


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