Anesthesia Coding Alert

Verify the diagnosis and know the code range to head in the right direction

If your pain management providers administer facet injections regularly, pay attention to these key areas to help make sure your claims aren't denied.

Verify That the Diagnosis Is Appropriate

Physicians use facet injections to help relieve the pain of many common--and a few less common--conditions. These can include spondylosis (721.x, Spondylosis and allied disorders), spondylolisthesis (756.12), facet syndrome (724.8, Other symptoms referable to back), and injury to the patient's median branch (955.1, Injury to peripheral nerve[s] of shoulder girdle and upper limb; median nerve), says Trish Bukauskas-Vollmer, CPC, MPC, owner of TB Consulting in Myrtle Beach, S.C.
 
Diagnosis checkpoint: Remember that approved diagnoses vary by carrier, says Myriam Nieves, CPC, ACS-PM, owner of Precision Medical Systems in Ft. Lauderdale, Fla.

"I recommend that coders familiarize themselves with their carrier's LCD [local coverage determination] since it can vary a great deal," she says.
 
For example, Tennessee's and Idaho's Medicare carriers only list three acceptable diagnoses for facet injections: 721.1, Cervical spondylosis with myelopathy; 721.2, Thoracic spondylosis without myelopathy; and 721.3, Lumbosacral spondylosis without myelopathy. Other states have a wider range of acceptable diagnoses.

"The most common diagnoses I see for facet injections are lumbago (724.2) and cervicalgia (723.1)," Nieves says. "But, once again, these are only approved by certain carriers."

Note: No matter what diagnoses your carrier accepts, remember to code according to the patient's record, not just to fit the diagnosis list.

Base Your Codes on Levels

When you code the facet injection, you should select from four choices:

• 64470--Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level
• +64472--... cervical or thoracic, each additional level (list separately in addition to code for primary procedure)
• 64475--... lumbar or sacral, single level
• +64476--... lumbar or sacral, each additional level (list separately in addition to code for primary procedure).  

Coding might seem easy because you simply pick the correct code based on the injection location and whether you're reporting a first level or additional injection. But reporting the correct number of levels can be more challenging than some coders realize. Stay tuned for next month's issue, when you'll learn how to avoid traps associated with reporting bilateral injections and following guidelines for injection frequency and numbers.