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Stacey Miller, CPC, is a senior coding review specialist for GENASCIS, a provider of billing, revenue cycle management services and supporting technologies for surgery centers.
Q: We recently received a code denial after performing facet joint injections. We performed four, so we 64493 x 1, 64494 x 1, and 64495 x 2, but had our 64495 code denied. Did we improperly code this?
Stacey Miller: CPT 64495 (Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure)) is reported just once for third and any successive levels by virtue of the code descriptor language (CPT 2010 Professional Book).
So if a physician performs facet joint injections at the following four levels: L1-L2, L2-L3, L3-L4, and L4-L5, the appropriate codes will be: 64493 x 1, 64494 x 1 and 64495 x 1. Under no circumstances can CPT 64495 be reported more than once.
Of note, the new facet injection codes for 2010 (64490-64495) include fluoroscopic and/or CT image guidance for the needle localization.
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The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
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