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Facet Arthrogram

B Posted Thu 11th of August, 2016 08:46:29 AM
my doctor is asking me for the CPT codes for the Facet Arthrograms he does. I have given him the following codes and he is telling me they are incorrect. could you tell me if there is another code we should be using? 64493 FACET JOINT LEVEL 1 (LUMBAR) 64494 FACET JOINT LEVEL 2nd LEVEL (LUMBAR) 64495 FACET JOINT LEVEL each additional LEVEL (LUMBAR) 64490 FACET JOINT INJECTION LEVEL 1 (CERVICAL) 64491 FACET JOINT INJECTION LEVEL 2 (CERVICAL) 64492 FACET JOINT INJECTION LEVEL each additional (CERVICAL)
B Posted Thu 11th of August, 2016 14:25:26 PM
Also, I explained the following to him but he is still insisting that the Arthrogram has a seperate code, please help... In 2010, there were major changes to the Facet Injection codes, and the Medicare List fee schedule is reimbursing significantly less for these procedures. These codes include the use of imaging, so the 77003 Fluoroscopy or other imaging technique codes are not billed separately with the new codes. The “Arthrogram” is a radiological exam in which contrast material is injected into the affected joint and it is included in the CPT code for facet joint injection i.e. 64490-64495
SuperCoder Answered Fri 12th of August, 2016 08:24:53 AM

You are absolutely right. The correct range of CPT codes for paravertebral spinal nerves and branches is 64490-64495. In medical coding, injection of diagnostic or therapeutic agent for cervical or thoracic facet joint(s)- single level use CPT 64490, +64491 is for second level and +64492 for third and each additional level of cervical or thoracic region. Whereas, for lumbar or sacral facet joint(s)- single level use CPT 64493, +64494 is for second level and +64495 for third and each additional level of lumbar or sacral region. And you are also right for image guidence concept, fluroscopy/CT and any injection of contrast are inclusive components of 64490-64495.

B Posted Fri 12th of August, 2016 08:25:58 AM
Thank you So to reiterate the Arthrogram is included in the injection codes and not separately coded or reimbursed
SuperCoder Answered Fri 12th of August, 2016 10:11:31 AM

Correct, arthrogram is a radiological exam in which contrast material is injected into the affected joint and it is included in the mentioned CPT code because the series is diagnostic or therapeutic both. So, in this service, the provider injects a diagnostic or therapeutic agent into a facet joint, at the Cervical, thoracic, lumbar or sacral level. Or he may perform the injection for nerves innervating that joint. He uses imaging guidance of either fluoroscopy or CT scan. The goal of this procedure is to treat spinal pain or to identify the exact source of pain.

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