Radiology Coding Alert

Question: May I separately report fluoroscopy if the radiologist uses guidance with a single-level facet injection?

Kentucky Subscriber

Answer: You may report fluoroscopic guidance for a facet injection with 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve, or sacroiliac joint], including neurolytic agent destruction).

If the radiologist also performs the single-level facet joint injection, choose the appropriate code from the following:

• 64470 -- Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level

• 64475 -- ... lumbar or sacral, single level, for single injections.

Tip: These codes are inherently unilateral. If the physician performs a bilateral injection, you should report the injection code with modifier 50 (Bilateral procedure).

Prepare yourself: You may be seeing more of these claims in the future. Some carriers are changing their guidelines for facet injections, requiring fluoroscopic guidance for confirmation that the physician correctly placed the needle either in the facet joint or at the location of the paravertebral facet joint nerve.