The format is identical to that used for the previous three World Cup qualification tournaments held by CONMEBOL.

The top four teams in the final standings qualified automatically for the 2010 FIFA World Cup.

[1] On 24 November 2008, FIFA suspended the Peruvian Football Federation from all international competition due to governmental interference in its operations.

The team from fourth place in the CONCACAF qualifying fourth round (Costa Rica) entered into a home and away play-off against the team which finished fifth in the CONMEBOL qualifying group (Uruguay).

The draw for the order in which the two matches were played was held on 2 June 2009 during the FIFA Congress in Nassau, the Bahamas.