Part B Insider (Multispecialty) Coding Alert

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

If you're providing more than a few facet joint injections per year, you may have to provide more supportive documentation, or the carriers will deny it, according to several of their local coverage decisions.
 
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, notes Trish Bukauskas-Vollmer, CEO of TB Consulting in Myrtle Beach, SC. "They will pay for more median branch facet nerve blocks rather than intraarticular facet joints because the physicians inject the nerve above the level and below the level for coverage of that facet."

Some carriers also may pay 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 it.

"Many carriers deny TPIs and ESIs with facets, because facets are diagnostic and when a physician is doing a facet they are looking to determine which nerve/facet needs treatment," notes Bukauskas-Vollmer. Plus, if the physician performs a facet joint injection along side a TPI or ESI "and the patient improves, what made the patient improve?" Bukauskas-Vollmer adds. It's sometimes hard to tell.

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 or spondylosis, she adds.