Facet joint interventions: OIG frowns on audit findings, prior auth goes live July 1

by Julia Kyles, CPC on Jun 1, 2023
Practices that regularly perform facet joint blocks (64490-64495) and denervations (64633-64636) are bracing for more scrutiny of their claims and challenges to getting paid.
A few months after Medicare Part B carriers implemented a national uniform policy for facet joint blocks and denervations the HHS Office of Inspector General (OIG) conducted an audit and discovered that providers quickly racked up more than $29 million in overpayments.
You can expect MACs to take more steps to curb improper payments. But they are already reviewing facet joint intervention claims and finding mistakes, according to Amy Turner, RN, BSN, MMHC, CPC, CHC, CHIAP, director of advisory solutions for Ventra Health.
Turner lists three areas where provider documentation regularly misses the mark in her handout for the June 6 webinar Facet Joint Interventions: Prepare for Prior Authorizations and More Medicare Audits:
  1. Conservative treatments before the first diagnostic block.
  2. Pain scores before and after the diagnostic blocks and denervation.
  3. Functional improvements after the blocks and denervation.
Turner also covers the information that providers must include in their notes to support their services’ medical necessity.
In addition, during the webinar Turner will help practices prepare for the new prior authorization requirements for facet joint interventions performed in the hospital outpatient setting.
According to Turner’s handouts, practices can submit prior authorization requests on June 15 for dates of service on or after July 1. Practices must submit the request before the service, and MACs have 10 days to issue a decision.
In addition, Turner will walk webinar attendees through the process of creating and submitting a complete request so they can avoid treatment delays, patient frustration and denied payments.
As a bonus, Turner will cover the uniform local coverage determination for sacroiliac joint services that five MACs implemented March 18 and the proposed uniform policy that four MACs have issued for comments.
The 60-minute webinar begins at 1 p.m. (ET) on June 6. It includes a live Q&A session and has been approved for 1 AAPC CEU.
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