Optum360 coding books logo
Optum360Coding.com
    Contact Us   (7 a.m.–7 p.m. CST)
  Home > Coding Central Articles > Coding Central Articles  
Coding Central
Coding Central Home
Inside Track to ICD-10
Coding Central Articles
Code This!
Case Studies
Chargemaster Corner

Articles for:
March 27, 2018


Spring OPPS Update Released

The Centers for Medicare and Medicaid Services (CMS) summarized the spring update to the outpatie... Learn More


Therapy Caps Repealed and Payment for Therapy Assistant Services Lowered

Medicare payment caps on outpatient therapy were permanently repealed effective January 1, 2018. ... Learn More


OIG Update Work Plan, Studies Cardiac Device Credits

In March, the Office of Inspector General (OIG) posted several updates to its existing Work Plan,... Learn More


View Article Archive

Subscribe:
To subscribe, paste this link into your preferred feedreader, or click on one of the buttons below:
 

Medical Coding News Archives

CMS Clarifies Facet Joint Injections Billing

 
August 11, 2009:

A recent Medicare transmittal has specified the proper billing of bilateral facet joint injections. The transmittal, published in July, addresses more than $100 million in improper payments to physicians and facilities identified by the Office of Inspector General (OIG).

An OIG investigation revealed that 63 percent of all facet joint injections allowed did not meet Medicare program requirements and resulted in approximately $96 million in improper payments to physician providers and another $33 million in improper payments to facilities. The transmittal specifically addresses billing of bilateral services, which accounted for 60 percent of the errors. See Ingenix Insights article “Facet Joint Injections Often Don’t Meet Payer Requirements,” posted on February 24, 2009.

According to the transmittal, modifier 50 should be appended when the documentation states that injections were made on the same level but on different sides. A physician should never use add-on code 64472 or 64476 when the documentation indicates that the injections were performed bilaterally. For example, if the documentation states that a facet joint was injected at the L2 level bilaterally, code 64475 should be reported with modifier 50, bilateral procedure, appended. 

NOTE: Report the name and dosage of the anesthetic and/or steroid agent administered with the appropriate HCPCS level II code separately.

Codes 64472 and 64476 are add-on codes identifying each additional level for the respective anatomical locations and as such are never reported as stand-alone codes and are also modifier 51 exempt. According to the Medicare Physician Fee Schedule Database for 2009, the standard multiple procedure (modifier 51) and standard bilateral surgery adjustments apply to these codes. Assistant-at-surgery (modifiers 80, 81, and 82), cosurgery (modifier 62), and surgical-team (modifier 66) concepts do not apply and therefore would not be paid for separately.

 

 
Sign in to
Your Account
USERNAME
Forgot your username?
PASSWORD
Forgot your password?
Don't have an account?
It's easy to create one.

Promo code

Have a promotional source code? Enter it here:


What is this?
Shop our catalog
Request or check out the electronic version of our latest catalog.

Medical Coding Books Winter 2018 Catalog