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Facet Injections

Certified Posted Thu 01st of May, 2014 10:16:31 AM

On Facet Injections, do we have to specify a RT or LT each time? Or does it make a difference?

SuperCoder Answered Thu 01st of May, 2014 17:00:46 PM

The rule of thumb is to count each spinal level the pain management physician treats. You report 64490 when the physician is injecting at the cervical or thoracic level and 64493 when the injection involves the lumbar or sacral level. You do not separately code for multiple injections at the same spinal level. Code 64490 is reported once for the first level (C3-4), 64491 is reported once for the second level (C4-5) and 64492 is reported once for any additional levels.

Tip: Append modifier 50 (Bilateral procedure) when the injections are given bilaterally. You count two units for bilateral injections at a level. "Some carriers want it 64490-50; others want 2 line items 64490 on the first line 64490-50 on the second," cautions Glidden, so check with your payer to avoid delays and denials. "The key is to check for your payer's preferences,"

do not typically bill bilateral injections as 2 units. You would rather bill them as either the single line item with modifier 50 and 1 unit of service or 2 line items -- 1 line item with modifier RT and 1 unit of service AND 1 line item with modifier LT and 1 unit of service."

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