Editor's Note: This article by Paul Cadorette, director of education for mdStrategies, originally appeared in The Coding Advocate, mdStrategies free monthly newsletter. Sign-up to receive this newsletter by clicking here.
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1. Report one code per level, but you can only report up to three levels. When documentation reads injection at C5-C6 and C6-C7, two levels are represented, so report CPT codes 64490 and 64491. When the documentation reads injection at C5, C6 and C7 (medial branch blocks) that would be three different levels reported with three CPT codes 64490, 64491 and 64492. However, when the documentation reads injection at C5 and C6 (medial branch blocks) that would be reported as 64490 - a single level injection, since each facet joint is innervated by two medial branch nerves. Injection of these two nerves achieves a blockade of only one facet joint, (See CPT Assistant Sep. 04: 01)
2. CPT code 64492 and 64495 represent third and any additional levels so you would NEVER report more than three facet injection codes for cervical/thoracic or three facet injection codes for lumbar/sacral regions.
3. Fluoroscopy or CT guidance are considered components of the CPT code so these types of image guidance would not be additionally reported, BUT USE OF FLUOROSCOPY OR CT IS REQUIRED TO ACCOMPLISH THE PROCEDURE – SO, IF IMAGE GUIDANCE IS NOT USED YOU WOULD REPORT 20550-20553.
4. Parenthetical notes in the CPT book are incorrect — they state if ultrasound guidance is used report 64999. THIS IS WRONG. When ultrasound guidance is used report the appropriate Category III code from the 0213T-0218T range. These codes are not listed in your CPT book but can be found on the AMA Website. http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/about-cpt/category-iii-codes.shtml
5. Facet Injections performed at the T12-L1 level should be reported with CPT code 64493 LUMBAR — this differs from CPT Assistant guidance that tells us to report 62310 (cervical/thoracic) when an epidural injection is performed at T12-L1. (Dec. 05 Special Issue Q&A)
6. Although the codes have changed you can still report bilateral procedures with modifier -50 or RT/LT as appropriate.
The information provided should be utilized for educational purposes only. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.