Pain management, anesthesia, orthopedic, physiatry & neurology coders get ready for a facet joint codes shift that preps for ICD-10.
The 2010 version of CPT attempts to organize the facet joint injection codes by deleting 64470-64476 and debuting 64490- 64495 in their place, as follows:
• 64490 — Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level
• 64491 — … second level
• 64492 — … third and any additional level(s)
• 64493 — Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level
• 64494 — … second level
• 64495 — … third and any additional level(s).
“Pain management coders are going to have to be on the ball to read these, to make sure that they don’t code these inappropriately,” says Leslie Johnson, CPC, quality control auditor for Duke University Health System and owner of the billing and coding Web site AskLeslie.net. “I like the fact that they include the terminology of ‘zygapophyseal joint’ and further expound with ‘or nerves innervating that joint,’” she says.
This means that there may be other eponyms or names for nerve blocks that may fall into this brand new CPT code description, Johnson says. “Physicians are going to have to be more specific if they are going to pinpoint the correct code(s) for what they’re doing,” she says. “If it’s stated as a ‘dorsal rami injection,’ will it be a third occipital nerve block (64450 if by scalp or 64999, unlisted) or will it be 64490?” Johnson asks.
Communication and partnership between the coder and the physician is going to be more crucial than ever before, Johnson says. “Watch for increasing levels of specificity to surface as we near the deadline date for the implementation of ICD-10.”
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