Facet injection trends in the medicare population and the impact of bundling codes.
Spine J. 2016 Mar 10;
Authors: Beckworth WJ, Jiang M, Hemingway J, Hughes D, Staggs D
BACKGROUND CONTEXT: Interventional spine procedures have seen a steady increase in utilization over the last 10-20 years. In 2010, the Current Procedural Terminology (CPT) Codes for facet injections were bundled with image guidance (fluoroscopic or computed tomography) and limited billing to a maximum of three levels. This was done in part because of the increased utilization and to ensure that procedures were done appropriately with image guidance.
PURPOSE: To evaluate if the CPT code changes correlated with a decrease utilization of facet injections.
STUDY DESIGN: Retrospective time-series study PATIENT SAMPLE: 100% Medicare Part B claims submitted for facet joint injections from 2000-2012 as documented in the Center for Medicare & Medicaid Services (CMS) Physician Supplier Procedure Summary (PSPS) master files.
OUTCOME MEASURES: Procedure numbers and trends METHODS: The trends of facet injections were analyzed from 2000-2012 using CMS PSPS master files. The total number of lumbo-sacral and cervical-thoracic facet injections were noted. Change over those years were calculated with specific attention to 2010 when CPT were bundled with image guidance and injections were limited to no more than three levels. Also, to account for the growth in the Medicare population, a calculation was done of injections per 100,000 Medicare enrollees. No funding was used for this study.
RESULTS: Facet injection utilization increased from 2000-2012 with an average growth rate of 11% per year for lumbo-sacral facet injections and 15% for cervical-thoracic facet injections (per 100,000 Medicare enrollees). The largest growth occurred from 2000-2006 (25% growth per year for lumbo-sacral and 32% for cervical-thoracic injections per 100,000 Medicare enrollees) and this leveled off from 2007-2012 (-3% growth per year for lumbo-sacral and -2% for cervical-thoracic injections per 100,000 Medicare enrollees). The biggest drop in these procedures was in 2010 when there was a drop of 14% for lumbo-sacral facet injections and 15% drop for cervical-thoracic facet injections (per 100,000 Medicare beneficiaries).
CONCLUSIONS: Facet injection utilization notably increased from 2000-2006 but began to level off from 2007-2012. The most notable drop was in 2010, which correlated with the release of new CPT codes that bundled image guidance and limited procedures to three levels or less.
PMID: 26972622 [PubMed – as supplied by publisher]