not an additional code to report for a fourth-level injection. Only one unit of the third-level codes should be reported per day regardless of the number of levels injected. (see CPT Assistant, February 2010.) Some Examples The following are examples of these coding situations in action: • a physician inserts two needles and injects medication around both medial branch nerves supplying the left l3-4 facet joint. although two nerves were blocked, they both supply the same facet joint, so this is a single-level block. Code 64493 (lumbar/sacral, single level) should be reported. • a physician performs bilateral facet joint injections at C4-5. This is a single-level block. since bilateral injections were performed, code 64490-50 (cervical/thoracic, single level, bilateral procedure) should be reported. • a physician injects the bilateral l2-l3 and l3-l4 facet joints. Two codes are reported: code 64493-50 (lumbar/sacral, single level, bilateral) and 64494-50 (lumbar/sacral, second level, bilateral). • a physician injects the right T9-T10 facet joint and the bilateral l3-l4 facet joints. Two codes are reported: code 64490 (cervical/thoracic, single level) and 64493-50 (lumbar/sacral, single level, bilateral). Open Communication and Guideline Review are Key It is important to communicate with physicians about the coding guidelines and documentation requirements for facet joint injections and medial branch blocks. most physicians will be receptive if approached with a request to “help me understand what you did for this patient” rather than a complaint that the documentation is inadequate. also, keep in mind that non-medicare payors may not follow medicare guidelines. For example, some payors may want a bilateral block to be reported as two codes or two line items instead of a single code with modifier 50. Be sure to review published payor guidelines prior to billing, and always check your payments to verify that the correct number of services were reimbursed. Jackie Miller, RHIA, CCS-O, CC, PCS, is vice president of product development at Coding Strategies, Inc. 32 HBma BIllINg • NOVemBer.DeCemBer.2014
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