Part B Insider (Multispecialty) Coding Alert

Hint:  Select the proper code based on injection site

Proper coding for facet injections depends on the diagnosis listed in the physician's documentation and how many units he administers.

Physicians use facet injections to help relieve the pain of many common--and a few less common--conditions. These can include spondylosis (721.x, Spondylosis and allied disorders), spondylolisthesis (738.4 or 756.12), facet syndrome (724.8, Other symptoms referable to back), and injury to the patient's median branch (955.1, Injury to peripheral nerve[s] of shoulder girdle and upper limb; median nerve), says Trish Bukauskas-Vollmer, CPC, MPC, owner of TB Consulting in Myrtle Beach, SC.

Remember that approved diagnoses vary by carrier, says Myriam Nieves, CPC, ACS-PM, owner of Precision Medical Systems in Ft. Lauderdale, FL.

For example, Tennessee's and Idaho's Medicare carriers only list three acceptable diagnoses for facet injections: 721.1 (Cervical spondylosis with myelopathy), 721.2 (Thoracic spondylosis without myelopathy), and 721.3 (Lumbosacral spondylosis without myelopathy).

You have four choices when it comes to coding for facet injections:

- 64470--(Injection, anethetic agent and/or steroid-)
- +64470--(-cervical or thoracic-)
- 64475--(-lumbar or sacral, single level)
- +64476--(-lumbar or sacral, each addtional level)

You should choose the correct code based on the location the surgeon injects and whether you-re reporting a first-level or additional injection.

Problem: Coders tell us that they find it difficult to code facet joint injections because they have trouble figuring out how many units to report.

Solution: If the physician 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. 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.

Don't forget: 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. Therefore, if the physician 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.