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New Facet codes for 2010

  1. #1
    Default New Facet codes for 2010
    Medical Coding Books
    Good Morning All!

    I just received my 2010 CPT book and as I was looking through I saw that they are deleting the facet injection codes(64470 - 64476) and adding new codes(64490 - 64495) that include fluoroscopic and/or CT guidance.

    I also saw that if no imaging is used we are to report trigger point injections codes for these injections. To me that doesn't seem right. Are they then going to fall under the trigger point LCD's? Will the trigger point LCD's be revised to include spinal dx codes then? It also said that if U/S guidance is used we are to report an unlisted code(64999).

    I am just looking for other's opinons on these new codes. I also wanted to know if anyone knew how the RVU's are going to change for these new codes since they include guidance.
    Missy Heuer CPC, CIRCC, CANPC

  2. Question
    Hi, I'm unsure of the RVUs and such for your question but I have one of my own on these codes. I'm so confused - perhaps it's just holiday brain dead but - 64492 says third level AND ANY ADDITIONAL LEVELS. All information I've read on it says that only 3 levels per day will be paid. Why then does it say any additional levels after it? My doc specializes in these, and other spinal joint injections, and its rare she has a patient needing only 3 levels worked on. Now we have to have the patient come back every 2 weeks instead of monthly.

    Jean Chasin, CPC

  3. #3
    Missy... Facet injections should ALWAYS be performed using some kind of guidance. If not, then the accurate placement of the needle is not guaranteed, and they are no better than a trigger point, hence the ruling. You do not need a spinal dx for trigger points since they are injected into muscles, not bone. The trigger point LCD's inculde dx's for all muscles.

    Jean... Facet injections are diagnostic by nature, therefore the reasoning for only allowing 3 levels at a time is that if you do more it becomes hard to identify the specific pain generator. The code descriptor is written that way so that you know that 64495 includes the third and any additional levels.

  4. Default
    Great reply Walker22 I agree! true facet joint injections cannot be performed without guidance of some sort. As to the ultrasound the AMA released new CAT III codes (T codes) for these effective Jan 1, 2010. They are not listed in 2010 CPT because they were in an update after CPT had been released. 0213T- 0218T see the AMA's website for CAT III updates.

  5. Default 64490-64495
    How do we report 64470 now? I cannot find a match for steroid specific injection.

  6. #6
    If the facet injection is being done with fluoroscopic or CT guidance the code would be 64490. If ultrasound guidance is being used then you would use code 0213T and if no guidance is used codes 20550 - 20553.

    The new facet codes include guidance. The new codes 64490 - 64495 in the 2010 CPT book.
    Missy Heuer CPC, CIRCC, CANPC

  7. #7
    St. Joseph County, Indiana

    64470/64472 is d-e-a-d. The new code is 64490/64491/64493. Ditto for 64475...etc

    Also, in general, medial branch blocks/facet injections/paravertebral nerve blocks are entirely diagnostic not therapeutic. Steroid generally isn't used.

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