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2010 CPT Changes for Paravertebral Facet Joint Injections & Guidance

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NCCI's most recent edits include significant changes for coding and billing facet joint injections. As of 2010, CPT codes for facet joint injections will include guidance for locating the injection site and will limit the number of levels that can be billed at three per day, according to Lynn Kuehn MS, RHIA, CCS-P, FAHIMA, a healthcare coding consultant with Murer Consultants.

Previous codes assigned for paravertebral joint injections did not include guidance that is used to help the physician locate the injection site, so guidance was billed separately for fluoroscopy (CPT 77003) or CT guidance (which actually did not have a code). Now, claims will be rejected if they include separate codes for the injection and guidance, according to Ms. Kuehn.

Codes for paravertebral facet joint injections, with guidance, are as follows:

•    Cervical or thoracic injections:
o    CPT 64490 — First or single level, with fluoroscopy or CT guidance
o    CPT 64491 — Second level, with fluoroscopy or CT guidance
o    CPT 64492 — Third and any additional levels, with fluoroscopy or CT guidance

•    Lumbar or sacral injections:
o    CPT 64493 — First or single level, with fluoroscopy or CT guidance
o    CPT 64494 — Second level, with fluoroscopy or CT guidance
o    CPT 64495 — Third and any additional levels, with fluoroscopy or CT guidance

According to Ms. Kuehn, physicians who do not use guidance to perform facet joint injections cannot use these CPT codes and instead must use musculoskeletal codes, such as codes for tendon sheath or trigger point injections (CPT 20550-20553).

Ms. Kuehn also says that some physicians may choose to use ultrasound guidance for facet joint injections. In those cases, the injections should be billed using Category III codes 0213T-0218T, which mirror CPT 64490-64495.

The information provided should be utilized for educational purposes only. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.

Learn more about Murer Consultants.

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