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Facet Injections billed to medicare

Tania Posted Wed 14th of August, 2013 12:20:07 PM

Please advise the proper way to bill '64493' '64494' '64495' to Medicare. We are billing with 77002 and the injections are denying as no medically necessary.

SuperCoder Answered Wed 14th of August, 2013 16:37:09 PM

You may override the related edits with a modifier when the fluoroscopic guidance is unrelated to the lumbar or sacral injection codes in your question.

The Correct Coding Initiative (CCI) edits bundle 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, or subarachnoid]) into the following codes:

64483, Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level
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.
The edits make sense because both 64483 and 64493 include fluoroscopic guidance in their descriptors. Additionally, parenthetical notes with the codes in CPT® state that fluoroscopic guidance and localization are inclusive components of 64479-64484 and 64490-64495, and the codes in question fall in these ranges.

The CCI edits have a modifier indicator of 1, which means you may use a modifier to override the edits under appropriate circumstances. For instance, an appropriate circumstance could involve the bundled service being performed at a separate session during a distinct procedure. CMS offers more information on overriding edits in the “Modifier 59 Article” available in the Downloads section at www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html.

The fluoroscopic guidance code is not reportable with the injection codes, which bundle the image guidance when fluoroscopy or CT imaging is used. The 2012 changes in CPT® bundle imaging guidance in 27096 (Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance [fluoroscopy or CT] including arthrography when performed), whereas 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) and 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 [List separately in addition to code for primary procedure]) already included fluoroscopy.

You shouldn't bill separately for 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, or subarachnoid]) when reporting these injection codes.

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