Facet Joint Injection Coding for 2010

December 8, 2009

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.

Want to learn more from Marvel Hammer about the changes in store for pain management reimbursement? Come to her audio conference on Thursday.

Related articles:

MAC Auditors Will Stick It To Facet Joint Injection Claims We hook you up with CMS instructions for when…
Pain Management Coding Update: Facet Joint Injection CPT Changes for 2010Pain management, anesthesia, orthopedic, physiatry & neurology coders get ready…
Audit Hot Spot: Facet Joint Injection ClaimsHere’s why the OIG wants to stick it to facet…

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