REVENEWS


OIG examines facet joint injections, and prompts code changes

With the increase of Medicare Part B payments for facet joint injections from $141 million in 2003 to $307 million in 2006 and an increase in claims by 76%, the Office of Inspector General (OIG) recently released a report examining Medicare Part B payments for facet joint injections. The OIG’s objectives were to determine the extent to which Medicare Part B payments for facet joint injections met Medicare program requirements and to determine what policies and safeguards existed to ensure that they were.

They found that 63% of facet joint injection services allowed by Medicare in 2006 did not meet program requirements, resulting in approximately $96 million in improper payments. In addition 33% of facet joint injections had documentation errors and 31% had coding errors. When coding errors were identified, just over 60% were overpaid due to physician incorrect billing additional add-on codes to represent bilateral injections instead of using modifier 50. 8% of services had a medical necessity error and 14% had one or more overlapping errors. Injection services provided in an office were more likely to have an error than those provided by an ambulatory surgical center or hospital outpatient department.

They found that in 2006 most carriers had policies and safeguards for facet injection services but there were limits to them. The limits were the complexity of creating frequency limits in LCD’s for facet joint injections due to the lack of consensus in the medical community about appropriate frequency of injections and the difficulty in automating frequency edits for facet joint injections due to the fact that the information required is not currently available on Medicare claims.

Obviously changes were needed, so effective January 1, 2010 the American Medical Association (AMA) made significant changes to the Current Procedural Terminology (CPT) codes, including the deletions of codes 64470-64476 to be replaced by:

64490: Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or computed tomography [CT]), cervical or thoracic; single level

+64491: Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level.

+64492: Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; third and any additional level(s)

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: Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level

+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)

64490–64492 should be used to report injections at the cervical and thoracic levels and 64493–64495, for injections at the lumbar or sacral area. 64490/64493 for a single or the first level injected and add-on codes + 64491/+64494 for the second level. +64492/+64495 for injections in the third level and any additional levels. You should not report code +64492/+64495 more than once per service date. Add-on codes are not subject to a multiple procedure reduction, therefore you should not append modifier -51 (multiple procedure) to any of these codes. These codes refer to unilateral injections and should be appended with modifier -50 when reporting bilateral procedures. Medicare will no longer pay for more than three levels for facet joint injections.

It should be noted that the codes now include fluoroscopy or CT guidance for needle placement; effective January 1, 2010 radiological imaging is bundled and no longer separately billed, but there are new Category III codes to report facet injections with ultrasound guidance for needle placement (0213T- 0218T). Although these codes will not be published in the CPT Manual until 2011, these codes are effective January 1, 2010 and should be used to indicate facet injections with ultrasound needle guidance.

Hopefully these new codes will eliminate confusion and coding errors and increase proper reporting and payments for facet joint injections.

Source:

http://www.oig.hhs.gov/oei/reports/oei-05-07-00200.pdf

Cassano, Holly. “Code changes should help ease the pain when coding for facet joint injections.” HCPro justcoding.com 27 January 2010.