Neck and back pain are a common problem in the US. According to a 2019 study by the CDC and the National Center for Health Statistics, 39.0% of adults reported experiencing back pain in the last 3 months [1]. Back pain can be treated with a variety of methods, from surgery and injections to medications, physical therapies, chiropractic therapies and even some home remedies.
What to look for?
Appropriate billing for spinal injections varies depending on several factors, including, but not limited to, the type of injection, the facility where the injections are performed, the provider performing the injections, and any modifiers appended to the CPT codes. Understanding the various spinal injection codes can feel overwhelming even for an experienced coder. Epidural steroid injections, for example, are commonly used to reduce inflammation, while facet joint injections target specific joints in the spine. Medicare and other insurance companies typically only cover epidural steroid injections (ESIs) if deemed medically necessary. ESIs can be safely injected 3-4 times per year, with a minimum duration of at least two weeks.
So, where do you start?
The CPT Code ranges to look for are:
62320-62323. These codes specifically relate to the injection of diagnostic or therapeutic agent, interlaminar epidural or subarachnoid.
64479-64484. These codes specifically relate to the injection of anesthetic agent and/or steroid, transforaminal epidural.
64490-64495. These codes specifically relate to the injection of diagnostic or therapeutic agent, paravertebral facet joint.
HCFS has you covered!
Navigating the complexities of spinal injection billing can be difficult given the intricate nature of these procedures and the evolving landscape of healthcare regulations. If you’re using the HCFSPlatform™, we have you covered. We have many specific Alerts set up to flag claims related to spinal injections. Additionally, our Artificial Intelligence (AI) models can help identify spikes in billing and other anomalous billing patterns. Some of our alerts that can flag for inappropriate number of units, medically unnecessary and inappropriate modifiers are:
[2716-01] – INAPPROPRIATE NUMBER OF SERVICES, DIAGNOSTIC AND THERAPEUTIC, PARAVERTEBRAL FACET JOINT INJECTIONS
[2718-01] – INAPPROPRIATE NUMBER OF SERVICES, EPIDURAL STEROID INJECTIONS
[2719-01] – INAPPROPRIATE MODIFIER, EPIDURAL STEROID INJECTIONS, CERVICAL/THORACIC AND LUMBAR/SACRAL
[2274-01] – MEDICALLY UNNECESSARY: FREQUENT EPIDURAL INJECTIONS
[1] https://www.cdc.gov/nchs/products/databriefs/db415.htm
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