top of page

Coding and Billing Facet Joint Injections

Facet joint injections, vital for addressing back and neck pain, come with a coding complexity that demands precision. In the CPT® manual's nervous system section, you'll find six key codes dedicated to these procedures. Let's break down the essentials for correct coding:

Key Procedure Codes:

  • 64490: Injection, cervical or thoracic, single level

  • +64491: Second level (in addition to primary procedure)

  • +64492: Third and any additional level(s) (in addition to primary procedure)

  • 64493: Injection, lumbar or sacral, single level

  • +64494: Second level (in addition to primary procedure)

  • +64495: Third and any additional level(s) (in addition to primary procedure)

Report these codes once per level, per side, regardless of the number of needle placements. Modifier 50 signifies a bilateral procedure. For bilateral injections at different levels, use the appropriate add-on code with modifier 50.

Examples:

  1. Unilateral injection at L3-4: Report 64493.

  2. Bilateral injections at L3-4 and L4-5: Report 64493-50 for L3-4 and 64494-50 for L4-5.

Avoiding Common Errors: The Office of Inspector General (OIG) flags errors, especially related to bilateral injections. Code accurately; for instance, use 64493-50 for a unilateral lumbar facet block.

Important Note on Image Guidance: Do not bill separately for image guidance, be it fluoroscopy or CT. If ultrasound guidance is employed, report using 0213T-0218T. Without imaging, opt for 20552-20553 for trigger point injections.


Add-on codes +64491, +64492, +64494, and +64495 are not reported with modifier 50, but are billed twice for bilateral procedures. Coding and Billing Facet Joint Injections


Codes 64490-64495 describe unilateral procedures. If the provider addresses both the left and right side at the same level, CPT® guidelines allow modifier 50 to report a bilateral procedure on the initial single level. The add-on codes are reported twice when performed bilaterally on additional levels. These codes include image guidance, (CT or fluoroscopy) are not reported separately.


Coffee mug from Medical coding by Jen at cost, just click below!


A paravertebral facet joint injection (64490-64495) may involve injection of a steroid and an anesthetic agent into the facet joint of a vertebra, or around the facet joint nerve, to relieve chronic low back pain. The paravertebral somatic nerves (64490-64495) are distinguished from the paravertebral sympathetic nerves (64520). These nerves curve around each vertebra. Blocks to these nerves and other regional blocks may be used to diagnose and treat certain pain disorders.


EXAMPLE: The physician provides diagnostic nerve blocks for C2, C3, and C4. Coding is based on the number of levels rather than the number of injections. There are two levels (the joint at C2/C3 and the joint at C3/C4).


Apply 64490 for the first level and add-on code +64491 for the second level.


EXAMPLE:

A patient receives a paravertebral facet joint injection with fluoroscopic guidance at two levels on both sides of the lumbar spine (L1-L2, and L2-L3) for pain. What CPT® and ICD-10-CM codes are reported?


A.64493, 64494, M54.4

B.64493, 64494, 77002, M54.4

C.64493-50, 64494 x 2, M54.50

D.64493-50, 64494-50, 77002, M54.50



Answer: C. 64493-50, 64494 x 2, M54.50

L1-L2 and L2-L3 indicates two levels. 64493 is reported for the first level, and 64494 is reported for the second level. Parenthetical instructions below the heading of Paravertebral Spinal Nerves and Branches indicate to add a modifier 50 to code 64493 and report add-on code 64494 twice if the procedure is performed bilaterally. Fluoroscopic guidance is not reported because it is included in the code description. Pain lumbar region = M54.50.



EXAMPLE:

What CPT® and ICD-10-CM codes are reported? Coding and Billing Facet Joint Injections


A.64493, 77002, G89.29, M51.36

B.64493 x 2, G89.29, M51.36, M51.37

C.64493-50, G89.29, M51.37

D.64493-50, 77002, M51.36, G89.29


Preoperative Diagnosis:

1. Chronic lumbar pain 2. Mild degenerative disc changes L5-S1, L4-5, L3-4

Operation Performed:

1. Bilateral L4-L5 lumbar facet joint medial branch block 2. Fluoroscopic guidance and localization

Technique:

The patient was placed on the fluoroscopy table in the prone position and the bilateral L4 and L5 facet joint medial branch nerves were identified under fluoroscopy and appropriate starting locations were marked on the skin. All areas were then prepped and draped in the usual sterile fashion and subsequently infiltrated with 2 percent lidocaine carried down into the subcutaneous tissues.

Under fluoroscopic guidance, 3 1/2 inch 22-gauge curved-tipped spinal needles were placed with their tips reaching the junctures of the transverse process attachments with the vertebral bodies in the superior aspect of the regions known to contain the medial branches to the facet joints of each of the respective levels. A small amount of Isovue M non-ionic contrast was injected through each of the needles to ascertain correct needle positioning prior to subsequent injection of 0.5 cc of Depo-Medrol followed by 1.0 cc of 0.25% Novacain without preservative was injected through each of the needles, and then the needles were removed.

The patient tolerated the procedure without complication and was stable at the time of discharge. The patient was advised not to operate motor vehicles for 24 hours and was given strict worsening precautions; including possible development of decreased level of alertness, bladder and bowel difficulty, spinal headache, lower extremity coordination or weakness, and to contact myself or seek evaluation at the nearest emergency department should any of these symptoms develop. The patient was instructed to follow-up with me in two weeks in Outpatient Surgery Clinic.



Answer: C. 64493-50, G89.29, M51.37

Only one facet joint is mentioned, the joint between L4 and L5. Parenthetical instructions below the heading of Paravertebral Spinal Nerves and Branches indicate to add a modifier 50 if the procedure is performed bilaterally. Fluoroscopic guidance is not reported because it is included in the code description. The reason for the encounter is for pain control pain management. Pain chronic G89.29. Degeneration, degenerative disc disease which states to see Degeneration, intervertebral disc. Degeneration intervertebral disc lumbosacral region = M51.37.


Fossa—Hollow cavity.

Decompression—When referring to nerves of the spine: Freeing of a pinched nerve, for instance from between adjacent vertebrae.

Zygapophyseal Joint (Z Joint, Paravertebral Facet Joint, Facet Joint)—Located on the posterior spine on each side of the vertebrae where it overlaps the neighboring vertebrae; the facet joints provide stability and give the spine the ability to bend and twist. They are made up of two surfaces of the adjacent vertebrae that are separated by a thin layer of cartilage. Medical Coding and Billing Facet Joint Injections with question examples AAPC AHIMA Exam Prep Tips!


Check out my Integumentary and Musculoskeletal study guide that contains lots of exam question practice and tips to help you during your exam. CLICK BELOW LINK

Medical Coding and Billing Facet Joint Injections with question examples AAPC AHIMA Exam Prep Tips, I hope this helps!

Post: Blog2_Post
bottom of page