Coding Facet Joint Injections GUIDELINES FOR THEIR PROPER USE By Jackie Miller, RHIA, CCS-P, CPC 2008, the Department of Health and Human Services Office of Inspector General (OIG) published some alarming results from an audit of Medicare facet joint injection claims. (See “Tricky Facet Joints” in the May/June 2009 issue of Billing for more information.) The audit was triggered by a massive 76 percent increase in Medicare payments for facet joint injections from 2003 to 2006. After reviewing a large sample of claims from 2006, the OIG concluded that 63 percent of the services did not meet Medicare payment criteria due to lack of documentation, incorrect coding, or lack of medical necessity. Worse, 82 percent of the coding errors resulted in overpayments. In 2010, in an effort to improve coding accuracy and decrease billing errors, the Current Procedural Terminology (CPT) editorial Panel deleted the existing facet joint injection codes (64470-64476) and replaced them with a new set of codes with different structure and guidelines. This article will review the current codes and the guidelines for their use. The Procedure The facet joints are located between each pair of adjacent vertebrae. There is a right and a left facet joint at each level. The facet joints 30 HBma BIllINg • NOVemBer.DeCemBer.2014 are essential in permitting the spine to flex and extend. However, they can also be the source of back, neck, or extremity pain. Facet joint injections usually include both local anesthetic and steroid medication. The injection is performed under imaging guidance, and the physician may inject contrast to visualize the anatomy and ensure correct needle placement in the joint. The procedure may be performed under moderate sedation, which is separately reportable if appropriately documented. The facet joints are innervated by the medial branches of the spinal nerves, and in some cases the physician will perform a medial branch nerve block rather than injecting directly into the facet joint. The spinal nerve at each vertebral level divides into ventral and dorsal (anterior and posterior) branches just past the point where it exits through the intervertebral foramen. The dorsal (posterior) branch then gives rise to the medial branch. each pair of facet joints is innervated by the medial branches of two different spinal nerves. For example, the medial branches from the l1 and l2 spinal nerves supply the facet joints at the l2-l3 level. This means that the physician must perform two medial branch injections to treat pain arising in a single facet joint. For coding purposes, these two medial branch injections are considered a single-level facet joint injection. With medial branch blocks, coding staff must read the physician’s procedure note carefully and count the number of levels that are In After reviewing a large sample of claims from 2006, the OIG concluded that 63 percent of the services did not meet Medicare payment criteria due to lack of documentation, incorrect coding, or lack of medical necessity.
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