Orthopedic Coding Alert

Hint: You may be reporting too many units of 64470-64476 When billing facet joint injections (64470-64476), do you report multiple units of service for multiple injections at the same spinal level? Unless the surgeon performs bilateral injections, you are probably overbilling the physician's service .

Check out the top five facet joint injection questions that readers submitted to us, along with expert recommendations on how to report the procedures. Does 1 Level Equal 1 Code?
 
Question 1. Our orthopedic surgeon administered two injections to block the medial branch nerve inside the joint at T1/T2 because one nerve branch sits at the top of the facet joint and a second branch sits at the bottom. Which codes should we report? Answer: You should report one unit of 64470 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level) and call it a day.

If the surgeon administers more than one injection at the same spinal level and on the same side of the spine, you should report only a single unit of service to most payers, says Trish Bukauskas-Vollmer, CPC, owner of TB Consulting in Myrtle Beach, S.C.

The descriptor for 64470 specifically notes "single level" and not "per injection," so you should never report two units of 64470 for several injections to one side of a spinal level.

Remember: Although the facet joint injection descriptors specify spinal "levels," the surgeon actually targets facet joint injections at the space between vertebrae, not at the vertebrae themselves, says Susan Allen, CPC, CCS-P, coding manager and compliance officer for Florida Spine Institute in Clearwater, Fla.

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

Another example: Suppose the surgeon performs two unilateral facet joint injections at T1/T2 and two more at T2/T3. You should report one unit of 64470 and one unit of +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]). Can We Report Fluoro With Facet Joint Injection? Question 2: Our surgeons normally use fluoroscopic guidance to place the needle for facet joint injections. Can we bill separately for the fluoroscopy? Answer: Yes. You should report a single unit of 76005 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet [...]