Neurology & Pain Management Coding Alert

Question: How can I distinguish facet joint injections (64470-64476) from epidural blocks (62280-62282)?


Delaware Subscriber


Answer: Facet joint injections and epidural blocks differ in a number of ways, but primarily they differ according to what, exactly, the neurologist injects.

Codes 64470-64476 and the term "facet joint injection" describe two distinct but related procedures.

The first type of injection, sometimes referred to as an intra-articular block, involves the injection of anesthetic and/or steroid to denervate the paravertebral facet joint (the bony surface between vertebrae). In the second procedure, the physician targets the facet joint nerve, correctly called the median branch nerve.

Such injections can be therapeutic but are usually diagnostic, and in either case serve to block pain temporarily using an anesthetic agent and/or steroid.

Epidural blocks (62280-62282), on the other hand, describe injection of neurolytic substances. These injections are primarily therapeutic and provide pain relief by permanently destroying damaged nerves.

Generally, you can distinguish these procedures simply by noting the substance the physician injects. For steroids or anesthetics, call on 64470-64476. You should choose a code appropriate to the location the neurologist treats (such as 64470, Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level).

For neurolytic substances, such as alcohol, phenol or iced saline solutions, you should choose from 62280-62282 - again, as appropriate to location (for example, 62280, Injection/infusion of neurolytic substance [e.g., alcohol, phenol, iced saline solutions], with or without other therapeutic substance; subarachnoid).