Wiki Facet joint procedures

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ralford444

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Our doctors are performing radiofrequency ablation of the lumbar and sacrial (S1,3,5) he is also doing the L1,L2,L3) UHC and Aetna are denying for the number of units should we only bill each region as one unit, or can we break them out as single units?

Thanks,
 
RF Abalation

I code for the facility and I usually break them out. I have not seen a problem with reimbursement.
 
I've never had that issue in the office setting. I bill ours out as single units and we get reembursed for each regardless of the carrier.
 
We have seen where Aetna will only allow for 6 units. So if your physician is doing both RT & LT they should allow 6 units for each side.

UHC is bad about denying these anyway, but what they are wanting to see in documentation is the conservative treatment before the ablation. We fight UHC on a constant basis, but we have worked with our physician on the documentation and we are getting better paying results the first round.

Documentation is the key to these procedures and making sure you meet their guidelines. Check their policy on ablations to make sure you meet everything.

Hope this helps.
 
Aetna is particularly picky when it comes to these procedures. See Aetna Medical Policy bulletin below:

VII.Non-pulsed radiofrequency facet denervation (also known as facet neurotomy, facet rhizotomy, or articular rhizolysis) is considered medically necessary for treatment of members with intractable cervical or back pain with or without sciatica in the outpatient setting when all of the following are met:

A.Member has experienced severe pain limiting activities of daily living for at least 6 months; and
B.Member has had no prior spinal fusion surgery; and
C.Neuroradiologic studies are negative or fail to confirm disc herniation; and
D.Member has no significant narrowing of the vertebral canal or spinal instability requiring surgery; and
E.Member has tried and failed conservative treatments such as bed rest, back supports, physiotherapy, correction of postural abnormality, as well as pharmacotherapies (e.g., anti-inflammatory agents, analgesics and muscle relaxants); and
F.Trial of facet joint injections has been successful in relieving the pain.

Non-pulsed radiofrequency facet denervation is considered experimental and investigational for all other indications because its effectiveness for indications other than the ones listed above has not been established.

Only 1 treatment procedure per level per side is considered medically necessary in a 6-month period.
 
Just in case you should need it, here is Aetna Medical Policy Bulletin on Facet joint injections:

I.Facet joint injections (intraarticular and medial branch blocks) are considered medically necessary in the diagnosis of facet pain in persons with chronic back or neck pain (pain lasting more than 3 months despite appropriate conservative treatment).

Facet joint injections (intraarticular and medial branch blocks) are considered experimental and investigational as therapy for back and neck pain and for all other indications because their effectiveness for these indications has not been established.

A set of facet joint injections (intraarticular or medical branch blocks) means up to 6 such injections per sitting, and this can be repeated once to establish the diagnosis. Additional sets of facet injections or medial branch blocks are considered experimental and investigational because they have no proven value.

Aetna considers ultrasound guidance of facet injections experimental and investigational because of insufficient evidence of its effectiveness.
 
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