Revenue Cycle Insider

Question: A provider used ultrasound guidance when performing an injection in the zygapophyseal joint. Is this included in code 66490?

Idaho Subscriber

Answer: No. CPT^® code 66490 (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) is a good call for reporting the injection itself, but you can see from the code descriptor that while some imaging guidance, including fluoroscopy and computer tomography (CT) are included, ultrasound is not. Therefore, you should look to a Category III code instead.

For the single-level injection with ultrasound guidance, report 0213T (Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level) instead, if the payer allows it.

But check with the payer: Some payers may consider ultrasound guidance rather than fluoroscopy or CT guidance for facet injections as investigational and/or unproven, and thus may not cover the service.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC