Abstract
Background Context
Interventional spine procedures have seen a steady increase in utilization over the
last 10 to 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
increased utilization and to ensure that procedures were done appropriately with image
guidance.
Purpose
The study aimed to evaluate if the CPT code changes correlated with a decreased utilization
of facet injections.
Study Design
This is a retrospective time series study.
Patient Sample
The sample was composed of 100% Medicare Part B claims submitted for facet joint injections
from 2000 to 2012, as documented in the Centers for Medicare & Medicaid Services (CMS)
Physician Supplier Procedure Summary (PSPS) master files.
Outcome Measures
Procedure numbers and trends were the outcome measures.
Methods
The trends of facet injections were analyzed from 2000 to 2012 using the CMS PSPS
master files. The total number of lumbosacral and cervical-thoracic facet injections
was noted. Changes 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 to 2012, with an average growth rate
of 11% per year for lumbosacral facet injections and 15% for cervical-thoracic facet
injections (per 100,000 Medicare enrollees). The largest growth occurred from 2000
to 2006 (25% growth per year for lumbosacral and 32% for cervical-thoracic injections
per 100,000 Medicare enrollees) and this leveled off from 2007 to 2012 (−3% growth
per year for lumbosacral 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 lumbosacral facet injections and 15% drop for cervical-thoracic facet injections
(per 100,000 Medicare beneficiaries).
Conclusions
Facet injection utilization notably increased from 2000 to 2006 but began to level
off from 2007 to 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.
Keywords
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Article info
Publication history
Published online: March 10, 2016
Accepted:
March 4,
2016
Received in revised form:
February 11,
2016
Received:
September 27,
2015
Footnotes
FDA device/drug status: Not applicable.
Author disclosures: WJB: Grant: Mesoblast (C, Paid to the institution), outside the submitted work. MJ: Nothing to disclose. JH: Nothing to disclose. DH: Nothing to disclose. DS: Nothing to disclose.
The disclosure key can be found on the Table of Contents and at www.TheSpineJournalOnline.com.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
