RE: Facet Injections with 77077.
Hello. That is a great question you have here. The thing is althought there are no CCI Edits in place between 64490-64495 Injection(s), diagnostic or therepeutic agent, paravertebral facet(zygapophyseal) joint (or nerves innervating thatr joint) with imaging guidance (fluoroscopy or CT) coding is per level of vertebra injected of course 64490 1st Level Cervical, Thoracic +64491 2nd level Cervical, Thoracic. +64492 3rd level and all additional levels report +64492 only one time.
64493 1st Level Lumbar, Sacral or Coccygeal. +64494 2nd Level Lumbar, Sacral,Coccygeal. +64495 3rd level and all additional levels after the 3rd Lumbar, Sacral, Coccygeal. The issue is this, what type of imaging guidance did your physician use to perform the Facet Injection itself?
If he used Fluoroscopic guidance or CT guidance I would not separately report 77077 as it is a Joint Survey performed Radiographically X-ray exam to diagnose Rheumtaoid Arthritis and that's one of the diagnostic reasons a Facet Joint Injection is performed, to diagnose the source of the Joint pain in the spine, whether or not it is arthritis or another type of etiology causing the pain this procedure includes Fluoroscopy and Fluroscopy is bundled into the Facet Injection procedure.
Facet Joint Injections aside from being therepeutic to temporarily relieve joint or nerve pain they are primarily diagnostic to determine the source and extent of the
pain which could be arthritis, or other reasons. So the 77077 includes Flouroscopic imaging and Fluroscopic imaging is part of the Facet Injection do not report any type of imaging
in addition to the Facet Joint procedure codes
Hope this Helps. I specialize in all of areas of Interventional Radiology/Interventional Cardiology/ Interventional Vascular Surgery
and Neuro-Interventional both Vascular Neuro-Interventional and all Non-vascular Interventional Pain and Spine and Neurosurgery Coding.
Feel free to email me if you ever have any type of coding questions.
Erikbrown619@Yahoo.com
Erik Brown, CIRCC, CPC