Facet Joint Injection Coding for 2010
Posted on 08. Dec, 2009 by Editor in Hot Coding Topics
Marvel Hammer’s Quick Start Guide to changes you’ll face in 2010.
Tons of pain management coders gathered at the Orlando conference this week, and everyone was abuzz about the coding changes the painful reimbursement cuts their practices are going to get next year.
Some big news: Effective January 1, 2010 radiological imaging will be required and bundled for facet joint injections, confirmed instructor Marvel Hammer.
Old way: CPT 2009 used to ask us to separately report radiological imaging for needle placement (1 unit per spinal region for these codes):
77003: Fluoroscopic guidance for needle placement
77012: CT guidance for needle placement
76942: Ultrasound guidance for needle placement
New way: CPT 2010 codes to report facet injections include fluoroscopy or CT guidance for needle placement;
AND
New Category III CPT codes to report facet injections include ultrasound guidance for needle placement. (Effective 1/1/10, but won’t be published in CPT until 2011.)
The good news: A different code for the 2nd level and a distinctly different code for all other levels should end ‘duplicate’ denials and payer requirement for modifiers appended to add-on codes, Hammer predicts.
Also, bilateral procedures should be paid correctly, and it will be easier to track payments.
The bad news: Radiological imaging is bundled and no longer separately billable.
Also providers will not be paid for more than 3 levels of facet joint injections. Note: Some Medicare payers started to enforce limits on the number of levels to 2 or 3 after OIG’s 2008 report.
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Tincy von Atzingen
08. Dec, 2009
Marvel – listened to an AAPC audio conference that talked about new Category III codes for ultrasound guided pain injections. Codes started with 0213T. However, they are not listed in the new 2010 CPT nor in the errata. Do you know anything about these?
Caveda Otto
10. Dec, 2009
It has nothing to do with skill, good results, pain relief for months at a time, saving patient’s medications, money, GI bleeds and cardiac troubles Paraphrasing a Clintonian phrase: IT”S ABOUT NOT PAYING STUPID!
Editor
10. Dec, 2009
Hi, Tincy: The AAPC audio is correct. The codes just aren’t printed yet. Here’s a quote from Supercoder.com explaining what’s up with 0213T and other new CPT Cat III codes that take effect on Jan. 1 2010 but won’t make it to print until 2011.
Best, Erin Masercola, PhD, CPC, Editor
The new Category III codes for paravertebral facet joint injections with ultrasound guidance did not make the deadline to be included in the 2010 CPT book; however, the AMA does indicate that even though these codes won’t be published in CPT until 2011, they become effective for provider use on Jan. 1, 2010. The new Category III codes that you should use to report facet joint injections with ultrasound guidance instead of fluoroscopy or CT are:
• 0213T — Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level
• +0214T — … cervical or thoracic… second level
• +0215T — … cervical or thoracic… third and any additional level(s) (List separately in addition to code for primary procedure)
• 0216T — Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level
• +0217T — … lumbar or sacral… second level
• +0218T — … lumbar or sacral… third and any additional level(s) (List separately in addition to code for primary procedure).