Billing For bilateral Facet Injections

[donaldduck]

Lets say you do a three-level bilateral lumbar facet injection (L3-4, L4-5, and L5-S1). Is the 50 modifier only applied to the first level (64493) or is it applied to the other two levels (64494 and 64495). I was going over my compensation reports and it looks like my organization is only crediting me for the 50 modifier for the 64493 and not for the 64494 and 64495 meaning that I am not getting the wrvu for doing bilateral for the other two joints.

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[SgtThunderfistMD]

applied to all of them

 

[RoloTomassi]

Sometimes applied to all, sometimes only the first and the second and third are both x2, depending on payer preference.

You're lucky you got any credit, as almost no one pays for facet injections and if they did, almost no one pays for third level.

 

[painfree23]

Sometimes applied to all, sometimes only the first and the second and third are both x2, depending on payer preference.

You're lucky you got any credit, as almost no one pays for facet injections and if they did, almost no one pays for third level.

What do you do when a surgeon refers for facet injection? Do u educate about mbnb:RF? Or just do the facet?

 

[BobBarker]

Just do mbb/rf.

 

[Ducttape]

be careful with medicare. 3rd levels require extra documentation as to why that level is necessary.

 

[RoloTomassi]

What do you do when a surgeon refers for facet injection? Do u educate about mbnb:RF? Or just do the facet?

If they're sending you for facet injections that means they're not surgical and surgeon doesn't care what you do

 

[SSdoc33]

vomit

 

[Dr. Ice]

I think I vomit on the idea that someone would do 3 level bilateral intra articular facet injections. Like, might as well do the other lumbar levels at that point. Just bathe the whole spine

 

[CleanUp]

I think I vomit on the idea that someone would do 3 level bilateral intra articular facet injections. Like, might as well do the other lumbar levels at that point. Just bathe the whole spine

The ole C1-S1 FJI

 

[bedrock]

There is only one situation where I feel that three level bilateral IA facet injections would be appropriate.
—After severe whiplash/hyperextension injury in patients under 50 yrs old.

I’ve seen several high speed rear end collisions that needed that after failing conservative care.

One memorable patient fell off a garage and was hyperextended across an AC unit.

I actually had to do IA facets twice on that patient, because a 3 level bilateral was not enough and they required a final bilateral IA facet at an adjacent level.

That said, I do 3 level bilateral IA facets very rarely.

 

[Ronin1]

I have an ortho surgeon that does 3 level bilateral facets x3 with 120 mg depo every time Then tells them they need an RFA lol. Makes for a great conversation

 

[GlowInTheDark]

If they're sending you for facet injections that means they're not surgical and surgeon doesn't care what you do

That’s essentially our “code” between my surgeons and me when a certain referral reason comes that means “please, thank you, and sorry”

 

[bedrock]

If they're sending you for facet injections that means they're not surgical and surgeon doesn't care what you do

Sorry I missed this before. But yes it’s true.

 

[Taus]

Sorry I missed this before. But yes it’s true.

One of their many code-words for “you ain’t got to go home, but you gotta get the $&@ out of here….”

 

[Dr. Ice]

If they are axial pain without a spondy, they probably shouldn’t have gone to the surgeon in the first place, unless the surgeon gets all the new patients first.

If he’s getting referred axial pain, yeah he’ll say facet or bilateral sij or whatever

 

[clubdeac]

Now with medicare at least, you bill the -50 modifier only on the first level and then for the second level you bill 2 units and add the R and L modifiers. At least that's what they told us last year at the billing course. I've been doing that but have no idea what my billers are doing with the information.