Billing question: Pseudofacet injection for Bertolotti's patient

[William Sparrow]

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Patient with suspected Bertolotti's syndrome. Previously failed bilateral L3,4,5 diagnostic MBB's last year by another doc then came to me.

How would you guys bill for an intra-articular pseudofacet joint injection? 64493?

Thanks

 

[Ducttape]

64493 for lumbar

 

[RoloTomassi]

Facet injections with steroid usually aren't covered, even less chance a pseudojoint will be covered. I inject pseudojoint and SI, only bill the SI.

 

[Ducttape]

Facet injections with steroid usually aren't covered, even less chance a pseudojoint will be covered. I inject pseudojoint and SI, only bill the SI.

you can now get it covered with recent changes to Medicare LCD

LCD - Facet Joint Interventions for Pain Management (L38803)

Use this page to view details for the Local Coverage Determination for Facet Joint Interventions for Pain Management.

www.cms.gov

B. Therapeutic Facet Joint Procedures (IA):
Therapeutic facet joint procedures are considered medically reasonable and necessary for patients who meet ALL the following criteria:

1. The patient has had two (2) medically reasonable and necessary diagnostic facet joint procedures with each one providing a consistent minimum of 80% relief of primary (index) pain (with the duration of relief being consistent with the agent used); AND
2. Subsequent therapeutic facet joint procedures at the same anatomic site results in at least consistent 50% pain relief for at least three (3) months from the prior therapeutic procedure or at least 50% consistent improvement in the ability to perform previously painful movements and ADLs as compared to baseline measurement using the same scale; AND
3. Documentation of why the patient is not a candidate for radiofrequency ablation (such as established spinal pseudarthrosis, implanted electrical device).

Frequency Limitations: For each covered spinal region no more than four (4) therapeutic facet joint (IA) sessions will be reimbursed per rolling 12 months.

 

[RoloTomassi]

you can now get it covered with recent changes to Medicare LCD

LCD - Facet Joint Interventions for Pain Management (L38803)

Use this page to view details for the Local Coverage Determination for Facet Joint Interventions for Pain Management.

www.cms.gov

B. Therapeutic Facet Joint Procedures (IA):
Therapeutic facet joint procedures are considered medically reasonable and necessary for patients who meet ALL the following criteria:

1. The patient has had two (2) medically reasonable and necessary diagnostic facet joint procedures with each one providing a consistent minimum of 80% relief of primary (index) pain (with the duration of relief being consistent with the agent used); AND
2. Subsequent therapeutic facet joint procedures at the same anatomic site results in at least consistent 50% pain relief for at least three (3) months from the prior therapeutic procedure or at least 50% consistent improvement in the ability to perform previously painful movements and ADLs as compared to baseline measurement using the same scale; AND
3. Documentation of why the patient is not a candidate for radiofrequency ablation (such as established spinal pseudarthrosis, implanted electrical device).

Frequency Limitations: For each covered spinal region no more than four (4) therapeutic facet joint (IA) sessions will be reimbursed per rolling 12 months.

Yes talk about jumping through hoops though. Unfortunately not applicable to OP either

 

[Ducttape]

so in the cases where i do therapeutic MBB, as in the past, typically the patient will have had 2 successful MBB and failed RFA, or i do not do RFA because of AICD (i will do for implanted SCS and pacemakers).

so not a lot of hoops to go through.

getting back to the OP - yes you might not get 64493 approved. you can still order it as a TPI with fluoroscopy guidance =20550 +77003

 

[Orin]

Why not bill it as a small joint with fluoroscopic guidance?

 

[TIVAndy]

"Documentation of why the patient is not a candidate for radiofrequency ablation (such as established spinal pseudarthrosis, implanted electrical device)."

 

[deleted875186]

Small joint and fluoro, usually no with required

 

[SSdoc33]

agree. its not a facet. small or med joint with flouro

 

[Agast]

Facet injections with steroid usually aren't covered, even less chance a pseudojoint will be covered. I inject pseudojoint and SI, only bill the SI.

Are you documenting 3 positive SI joint physical exam findings?

 

[Ducttape]

But is it truly a joint?

 

[RoloTomassi]

Are you documenting 3 positive SI joint physical exam findings?

Yes

 

[pmrmd]

I bill for a TPI with fluoro. It is what it is.

 

[Greenbayslacker]

Are you documenting 3 positive SI joint physical exam findings?

Can you direct me to these guidelines? Also how about two PE findings plus radiographic evidence?