CODING COrNer injected, not the number of nerves. For example, the august 2010 issue of ama’s CPT Assistant newsletter points out that injection of the right l3, l4, and l5 medial branches should be coded as a two-level facet joint injection, since l3 and l4 innervate the l4- l5 level and l4 and l5 innervate the l5-s1 level. Imaging Guidance Facet joint injections and medial branch nerve blocks require imaging guidance. Without the use of imaging, the physician cannot ensure that the needle is correctly positioned. most injections are performed using fluoroscopy, but CT or ultrasound may be used instead. The injection codes include the imaging, so it is not necessary or appropriate to report imaging guidance codes together with the facet joint injection codes. The CPT manual indicates that “blind” injections (those performed without the use of imaging guidance) must be coded as trigger point injections (codes 20552- 20553) rather than facet joint injections. Code Assignment Facet joint injections and medial branch nerve blocks that are performed under fluoro or CT guidance are reported with codes 64490-64495. Codes 64490-64492 are used for cervical or thoracic procedures 64490 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level +64491 … second level (list separately in addition to code for primary procedure.) +64492 … third and any additional level(s) (list separately in addition to code for primary procedure.) Codes 64493-64495 are used for lumbar or sacral procedures 64493 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level +64494 … second level (list separately in addition to code for primary procedure.) +64495 … third and any additional level(s) (list separately in addition to code for primary procedure.) If the injections are performed under ultrasound guidance, the procedure is reported with Category III codes 0213T-0218T instead of 64490-64495. The Category III codes are structured the same way as Category I codes, and the guidelines for their use are the same. under the medicare Physician Fee schedule, codes 0213T- 0218T are designated as contractor priced. under the Hospital Outpatient Prospective Payment system, the base codes 0213T and 0216T are payable, but the add-on codes are packaged. The following table provides a quick reference to the injection codes: Level Cervical/Thoracic Lumbar/Sacral First . . . . . . . . . 64490 or 0213T . . . . 64493 or 0216T second . . . . . . 64491 or 0214T . . . . 64494 or 0217T Third & all . . . . 64492 or 0215T . . . . 64495 or 0218T additional all of the facet joint injection codes, including the Category III codes, are unilateral in nature. If the physician injects both sides of a vertebral level, the injection code must be reported with modifier 50 (bilateral procedure). When the physician injects two levels in the same region, both the single-level code and the second-level code should be assigned (for example, 64490 and 64491). If the physician injects three levels in the same region, three codes are needed – single level, second level, and third level (for example, 64490, 64491, and 64492). (see CPT Assistant, October 2012.) The third level injection codes (64492, 64495, 0215T, and 0218T) include the third-level and all additional levels. There is A Few Ways to Obtain CHBME Credits Attend HBMA conferences Take the quiz in Billing Purchase videos by module from the Executive Summit (located at the website) THe jOurNal OF THe HealTHCare BIllINg aND maNagemeNT assOCIaTION 31
Billing_NovDec14
To see the actual publication please follow the link above