january 2010

USE OF NEW FACET INJECTION CODES FOR 2010

1. Report one code per level, but you can only report up to 3 levels. When documentation reads injection at C5-C6 and C6-C7 that is two levels so report CPT codes 64490 and 64491.However, when the documentation reads injection at C5 and C6 (medial branch blocks) that would be reported as 64490 - a single level injection, since each facet joint is innervated by two medial branch nerves. Injection of these two nerves achieves a blockade of only one facet joint, (See CPT Assistant Sep. 04: 01)

2. CPT code 64492 and 64495 represent third and any additional levels so you would NEVER report more than 3 facet injection codes for cervical/thoracic or 3 facet injection codes for lumbar/sacral regions.

3. Fluoroscopy or CT guidance are considered components of the CPT code so these types of image guidance would not be additionally reported, BUT USE OF FLOUROSCOPY OR CT IS REQUIRED TO ACCOMPLISH THE PROCEDURE – SO, IF IMAGE GUIDANCE IS NOT USED YOU WOULD REPORT 20550-20553.

4. Parenthetical notes in the CPT book are incorrect – they state if ultrasound guidance is used report 64999, THIS IS WRONG. When ultrasound guidance is used report the appropriate Category III code from the 0213T-0218T range. These codes are not listed in your CPT book but can be found at the following link on the AMA Website.
http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/about-cpt/category-iii-codes.shtml

5. Facet Injections performed at the T12-L1 level should be reported with CPT code 64493 LUMBAR – this differs from CPT Assistant guidance that tells us to report 62310 (cervical/thoracic) when an epidural injection is performed at T12-L1. (Dec. 05 Special Issue Q&A)

6. Although the codes have changed you can still report bilateral procedures with modifier 50 or RT/LT as appropriate.