Neurology & Pain Management Coding Alert

Be prepared to appeal denials if you bill trigger points alongside nerve blocks

If your neurology practice is providing more than a few facet joint injections per year for the same patient, you may have to provide more supportive documentation, or carriers could deny your claims.
 
For example, HGSAdministrators says that more than four injections per level, per year, "will be reviewed on an individual consideration basis." This is because "long-term multiple nerve blocks over a period of several weeks or months is not an effective method of chronic pain management," HGSA says. Likewise, Regence Blue Cross of Utah says treatment "in excess of four injections" isn't covered without extra documentation.
 
"Insurance carriers will cover more than four facets if they are at multiple levels, for problems relating to larger areas of the back," or bilateral problems, says Trish Bukauskas-Vollmer, CPC, owner and CEO of TB Consulting in Myrtle Beach, S.C. "They will pay for more median branch facet nerve blocks rather than intra-articular facet joints because the physicians inject the nerve above the level and below the level for coverage of that facet," she says.
 
Some carriers may also pay for additional pain injections, such as an epidural or trigger point injections, in addition to facet joint injections. But some, like Regence, state that they won't cover facet joint injections alongside another pain management treatment unless "unusual circumstances" require such treatment.
 
"Many carriers deny trigger point or epidural injections with facet injections because facet injections are diagnostic, and when a physician performs a facet injection they are looking to determine which nerve/facet needs treatment," Bukauskas-Vollmer says.
 
Tip: You may achieve some success in appealing denials for other modalities and injections with facet joint injections if the patient also has a separate condition such as discogenic pain (for example, 722.2, Displacement of intervertebral disc, site unspecified, without myelopathy) or spondylosis (for example, 756.11, Spondylolysis, lumbosacral region), Bukauskas-Vollmer adds.