Skip to Main Content
 
 
 
Web Content Viewer

Policy Education Topics

Web Content Viewer
Web Content Viewer

Providers Performing Facet Joint Injections (CPT Code 64476) 

The OIG recently released the results of an investigation into facet joint injections. Per the OIG report:

"Facet joint injections are typically performed using radiological guidance (radiographic guidance or live x-ray) to ensure correct needle placement and avoid nerve or other injury. Sometimes, a physician performs the procedure without radiological imaging, which is referred to as a “blind” injection. One study of these “blind” injections concluded that facet joint injections should not be performed without the aid of radiological imaging because of potential risk to the patient and lack of diagnostic accuracy."

Since the utilization of these services has increased by 76 percent and payment for the services has increased by over $200 million dollars in less than three years, facet joint injections have become a service of interest for medical necessity, coding accuracy and compliance with regulatory requirements.

In response to this report, National Government Services is updating the claims processing edits for these services and the coding instructions for the LCD for Pain Management (L28529) to reflect that the accompanying radiological guidance, as required in the LCD, has occurred. Please see “Pain Management—Supplemental Instructions Article (A48042)” for more information.

Institutions and physicians must bill the fluoroscopy/guidance codes on the same claim as the injections. Since ASCs may not bill separately for the fluoroscopy services (which are included in the ASC charge for the injection service), they must append modifier KX to the injection code attesting to the fact that radiological guidance was utilized when the injection was performed.

The full OIG report can be accessed at http://oig.hhs.gov/oei/reports/oei-05-07-00200.pdf. (929.46 KB) Please also review the Pain Management LCD for other procedures that require radiologic guidance.

Related Content

Providers Performing Facet Joint Injections (CPT Code 64476) 
Web Content Viewer
Web Content Viewer
Complementary Content