Facet Joint Injections

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
June 8th, 2017

Medicare will consider facet joint blocks to be reasonable and necessary for chronic pain (persistent pain for three (3) months or greater) suspected to originate from the facet joint. Facet joint block is one of the methods used to document and confirm suspicions of posterior element biomechanical pain of the spine. Hallmarks of posterior element biomechanical pain are:

• The pain does not have a strong radicular component.
• There is no associated neurological deficit and the pain is aggravated by hyperextension, rotation or lateral bending of the spine, depending on the orientation of the facet joint at that level.

A paravertebral facet joint represents the articulation of the posterior elements of one vertebra with its neighboring vertebrae. The facet joint is noted at a specific level by the vertebrae that form it (e.g., C4-5 or L2-3). It is further noted that there are two (2) facet joints at each level; left and right.

The covered Current Procedural Terminology (CPT) codes reviewed are:
• CPT 64490 -Injections(s), diagnostic 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

(Appropriate Use of Modifier 50 and Add-On Current Procedural Terminology Codes (CPT) for Facet Joint Injection Services) clarifies the appropriate use of modifier 50 and add-on codes for facet joint injection services.

• CPT 64491 - Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level

• CPT 64492 - Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; third and any additional level(s)

• CPT 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

• CPT 64494 - Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level

• CPT 64495 - Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s)

• CPT 64622 - Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level

• CPT 64623 - Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, each additional level (list separately in addition to code for primary procedure)

• CPT 64626 - Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level

• CPT 64627 - Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, each additional level (list separately in addition to code for primary procedure)

• CPT 64999 - Unlisted procedure, nervous system

• CPT 77003 - Fluoroguide for spine inject

Medicare Quarterly Provider Compliance Newsletter – Volume 5, Issue 2 - January 2015

References:

Facet Joint Injections. (2017, June 8). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/facet-joint-injections-31518.html

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