# Help!! New facet blocks 64490-64495



## FractalMind (Jan 22, 2010)

Hi! new facet blocks cross to anesthesia codes 01935 & 01936 but, how do I determine if the block is "therapeutic" or "diagnostic"?? the doctors rarely document this and the most common dx's are: pain, DDD, stenosis, etc. do you think the POS has anything to do? for example one of our doctors has a pain clinic and problably his services are "therapeutic"? if you have any info. please help me,
Thanks!


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## hgolfos (Jan 22, 2010)

Educate your doctors on documentation.  The facet joint injection can be done for either reason, regardless of place of service.  We're having the same issues with ours.  The only other option is to obtain the operative report or call the performing physician's office for better info.


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## CVelez (Jan 26, 2010)

Are you sure of the codes we use 01992 or 01991 for nerve blocks

Charla


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## hgolfos (Jan 26, 2010)

Charla,

ASA 2010 Crosswalk crosses the new Facet Joint injection codes to 01935 and 01936.


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## CVelez (Jan 27, 2010)

Thanks for the info.   We have Ingenix cross coder and they do not have facets listed.  

But I am still confused because Florida Medicare has a new LCD (L30570) MAC for certain interventional pain managements services.  This specifically lists facet codes (64490-64495) and 01991 and 01992 for MAC. 

Medicare will no longer cover MAC for these procedures unless the patient has certian co-morbidities that would require an anestheologist. 

Charla


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## hgolfos (Jan 27, 2010)

Charla, 

I'm sorry, I'm really not familiar with the Florida carriers.  The only info I can offer you is that in CPT 01991 and 01992 only state in their descriptions that they are for nerve blocks while 01935 & 01936 are for percutaneous image guided procedures on the spine and spinal cord.


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## JERSEYSHORE (Oct 11, 2011)

*facet blocks*



choder said:


> Hi! new facet blocks cross to anesthesia codes 01935 & 01936 but, how do I determine if the block is "therapeutic" or "diagnostic"?? the doctors rarely document this and the most common dx's are: pain, DDD, stenosis, etc. do you think the POS has anything to do? for example one of our doctors has a pain clinic and problably his services are "therapeutic"? if you have any info. please help me,
> Thanks!



In my 2011 crosswalk book there is not anesthesia code, states 64490 through 64495 anesthesia  care not typically required. No anesthesia code listed


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## thandra (Feb 16, 2012)

*64490 Vs (01935 & 01936)*



choder said:


> Hi! new facet blocks cross to anesthesia codes 01935 & 01936 but, how do I determine if the block is "therapeutic" or "diagnostic"?? the doctors rarely document this and the most common dx's are: pain, DDD, stenosis, etc. do you think the POS has anything to do? for example one of our doctors has a pain clinic and problably his services are "therapeutic"? if you have any info. please help me,
> Thanks!



Does ASA cross walk support the ASA codes 01935 & 01936 against the CPT 64490?


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## aaron.lucas (Feb 21, 2012)

actually the 01935 and 01936 are incorrect.  01991 and 01992 should be used with all epidurals, facets, etc. as these codes specifically state they are for "nerve blocks and injections" (which is what a facet injection is), and they should be used based on the position of the patient.  01935 and 01936 would only be appropriate for other percutaneous spinal procedures (i.e. discography or spinal RFA).


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## dwaldman (Feb 21, 2012)

I had billed the same way as 01992 for facet injections but was then told that with the code descriptor change for 64490-64495 to include with image guidance, that the crosswalk  they were referencing which I believe was the ASA, was now saying 01935/01936 for 64490-64495


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## aaron.lucas (Feb 22, 2012)

the new descriptor does include image guidance, but rememeber when billing anesthesia you should always choose your code based on the PRIMARY procedure (i.e., the main reason they are there).  in this case the primary procedure is the injection, not the fluoro, so you would choose your anesthesia code based on that.  with a discography, the main purpose of the procedure is to take images and get a diagnostic impression (there may be an injection of contrast, but again that's not the primary procedure), so in that case 01935 would be appropriate.  unfortunately there's an error in the ASA crosswalk, and it's causing people a lot of confusion.


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