64475, 64475 -50 77033. Diagnosis: 721.3
64475: Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, single level.
64475 -50: Used to bill the injection for the second facet joints between L4-5.
77033: Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet nerve, or sacroiliac joint), including neurolytic agent destruction.
This was a scheduled visit for the injections and there was no significant, separately identifiable evaluation and management service done. Therefore, an office visit cannot be billed.
Many carriers require fluoroscopic guidance to be done in conjunction with any facet joint injections. The Current Procedural Terminology manual gives clear directions for the use of fluoroscopic guidance and localization for needle replacement and injection in conjunction with 64470-64484.
The ACR is finding that carriers are now performing audits on these codes and reviewing charts as far back as one year. The ACR suggests that practices review their carrier’s local coverage determination on facet joint injections and keep in mind that Medicare has the right to review all payments for medical necessity of claims billed.
If you have any questions or concerns on this matter, contact Melesia Tillman, CCP, CPC, at (404) 633-3777, ext. 820, or at mtillman@rhuematology.org.