title: Facet injection trends in the Medicare population and the impact of bundling codes.
abstract: 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.
  
  
  
  The study aimed to evaluate if the CPT code changes correlated with a decreased utilization of facet injections.
  
  
  
  This is a retrospective time series study.
  
  
  
  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.
  
  
  
  Procedure numbers and trends were the outcome measures.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: The Emory Spine Center, Emory University, 59 Executive Park South, Atlanta, GA 30329, USA. Electronic address: wbeckwo@emory.edu.
authors.forename: William Jeremy
authors.initials: WJ
authors.lastname: Beckworth
authors.affiliation: Harvey L. Neiman Health Policy Institute, 1891 Preston White Drive, Reston, VA 20191, USA; Department of Health Administration and Policy, George Mason University, 4400 University Drive, Fairfax, VA 22030, USA.
authors.forename: Miao
authors.initials: M
authors.lastname: Jiang
authors.affiliation: Harvey L. Neiman Health Policy Institute, 1891 Preston White Drive, Reston, VA 20191, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hemingway
authors.affiliation: Harvey L. Neiman Health Policy Institute, 1891 Preston White Drive, Reston, VA 20191, USA; Department of Health Administration and Policy, George Mason University, 4400 University Drive, Fairfax, VA 22030, USA.
authors.forename: Danny
authors.initials: D
authors.lastname: Hughes
authors.affiliation: Department of Physical Medicine and Rehabilitation, Emory University, 1441 Clifton Road, Atlanta, GA 30322, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Staggs
mesh_terms: D039702:Current Procedural Terminology; D006801:Humans; D006278:Medicare / Q000706:statistics & numerical data*; D019635:Neurosurgical Procedures / Q000145:classification / Q000706:statistics & numerical data* / Q000639:trends; D013122:Spinal Diseases / Q000601:surgery*; D014481:United States
keywords: Bundling; CPT; Cost; Facet injections; Medicare; Utilization