Anesthesia Coding Alert

Count levels treated -- not injections -- for 64470-64476

Coding for facet injections is fairly easy, as long as you count things correctly--and count the correct part of the procedure. Here are five easy ways to keep your facet injection coding on track.

The lowdown: When coding some injection procedures, you count the number of injections your physician administers. But you code facet injections based on the number of spinal facet joint levels he treats. You should report only a single unit of service for multiple injections at the same spinal level--unless your pain management specialist provides the injections bilaterally. Simply append modifier 50 (Bilateral procedure) for bilateral injections, but be careful to not exceed your carrier's utilization guidelines. 1. Choose 64472, 64476 for Additional Levels When reporting facet joint injections, you should choose either 64470 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level) or 64475 (... lumbar or sacral, single level), depending on the spinal area your physician treats.

For each additional level the physician injects in the cervical or thoracic area, report +64472 (... cervical or thoracic, each additional level [list separately in addition to code for primary procedure]). For each additional level he injects in the lumbar or sacral area, turn instead to +64476 (... lumbar or sacral, each additional level [list separately in addition to code for primary procedure]).

Clarify terminology: Although the descriptors for 64470-64476 specify spinal "levels," your pain management specialist actually targets facet joint injections at the space between vertebrae (in other words, the interspace), not at the vertebrae themselves, says Susan Allen, CPC, CCS-P, coding manager and compliance officer for Florida Spine Institute in Clearwater.

If the specialist documents, for instance, "Facet joint injection at C4-C5," this represents a single injection to the interspace between the fourth and fifth cervical vertebrae, not two separate injections at the fourth and fifth cervical vertebrae.

Example: Your specialist provides facet joint injections at L1-L2 and L2-L3. In this case, you would report 64475 (for the initial lumbar level) and 64476 (for the injection at the additional lumbar level). 2. Same-Level, Same-Side Injections = 1 'Unit' If the pain management specialist provides more than one injection at the same spinal level and on the same side of the spine, you may report only a single unit of service for most payers, says Trish Bukauskas-Vollmer, CPC, owner of TB Consulting in Myrtle Beach, S.C. Example: Your physician must administer two injections to block the medial branch nerves that provide sensory nerve supply to the facet joint. Why: One branch of the nerve sits at the top of the facet joint, and a second branch sits at the bottom.

Some coders mistakenly believe that [...]