Neurosurgery Coding Alert

Question: Should I report bilateral facet joint injections by using modifier -50 or by using the "each additional" codes?

Pennsylvania Subscriber

Answer: Codes 64470-64476, which describe facet joint injections, are unilateral codes, according to CPT Assistant. Therefore, if the physician provides the injections bilaterally, you are justified in seeking additional compensation.
 
CPT provides codes specifically to describe "additional levels," such as +64472 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, each additional level [list separately in addition to code for primary procedure]). Examples in CPT Assistant indicate that you can use this code to report the contralateral side and any additional levels. The Medicare Physician Fee Schedule database, however, reveals that Medicare allows you to report modifier -50 (Bilateral procedure) with these codes, and therefore you should select it as the preferred method to report a bilateral injection at the same spinal level.
 
For example, if the neurosurgeon provides injections at two cervical levels on each side of the spine, you should report 64470 (... cervical or thoracic, single level) with modifier -50 appended to describe the bilateral injection at the first spinal level and 64472-50 to describe the bilateral injection at the additional cervical spinal level.