MEDAC BILLING & COMPLIANCE ALERT
November 24, 2009

By: Bellinger P. Moody, RHIA, CPC, CCP
Executive Vice President of Compliance

New 2010 CPT Codes for Facet Blocks

The old Facet injection block codes, 64470-64476, have been deleted and replaced by codes 64490-64495. Now, there are 6 facet block codes, instead of four.  Additionally, fluoroscopy is now bundled into these codes for all payers. Consequently, the Facet Radiofrequency codes (64622, 64623, 64626, and 64627) have not changed. Therefore, fluoroscopy can still be billed with the facet Radiofrequency codes, and the number of levels of RF has not been restricted, as is the case with the new 2010 facet block codes.

For the facet blocks, instead of just one add-on code for each additional level, the new CPT nomenclature contains two add-on codes. The first add-on code is for the first additional level, but the second add-on code is for all additional levels after the second level, no matter how many additional levels are performed.  This change in coding limits the number of billed levels to 3, since the second add-on level is defined as "third and any additional level(s)." There are additional instructions which state that you can only bill one unit of the second add-on code, again meaning that once you reach your third level, you are doing the fourth and fifth levels for free.

Additionally, CPT 2010 has added instructions to resolve the debate over whether the T12-L1 interspace is lumbar or thoracic, the CPT Code now instructs everyone to use the lumbar codes for this interspace.

The information presented herein reflects general information that is current as of the date it is first published.  In light of changes that may occur in the health care regulatory and compliance environments, the author's presentation of this information and any general advice previously published might become outdated.  Please check with your individual legal and/or compliance advisor(s) prior to taking any significant actions based upon the information and advice presented.