Pain Management Coding Alert

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Look to these Codes on Paravertebral Facet Joint Injections

Published on Thu May 10, 2018

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Remember, not all payers have identical approved diagnoses.

When a patient reports to the PM specialist for a paravertebral facet joint injection in the cervical/thoracic or lumbar/sacral areas, you'll report the service with one or more of the following codes, depending on encounter specifics:

64490 - 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)
+64491 - ... second level (List separately in addition to code for primary procedure)
+ 64492 - ... third and any additional level(s) (List separately in addition to code for primary procedure)
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
+64494 - ... second level (List separately in addition to code for primary procedure)
+ 64495 - ... third and any additional level(s) (List separately in addition to code for primary procedure).

While there is no single source of approved diagnosis codes for these injections, there are a few that are commonly attached to one or more of the above codes. Those ICD-10 codes include:

M25.511 - Pain in right shoulder
M25.512 - Pain in left shoulder
M25.521 - Pain in right elbow
M25.522 - Pain in left elbow
M25.531 - Pain in right wrist
M25.532 - Pain in left wrist
M25.551 - Pain in right hip
M25.552 - Pain in left hip
M25.571 - Pain in right ankle and joints of right foot
M25.572 - Pain in left ankle and joints of left foot
M47.14 - Other spondylosis with myelopathy, thoracic region
M47.812 - Spondylosis without myelopathy or radiculopathy, cervical region
M47.817 - Spondylosis without myelopathy or radiculopathy, lumbosacral region
M47.892 - Other spondylosis, cervical region
M47.897 - Other spondylosis, lumbosacral region
M47.9 - Spondylosis, unspecified
M54.2 - Cervicalgia
M54.5 - Low back pain
M96.1 - Postlaminectomy syndrome, not elsewhere classified.

Remember: This is not a complete, or approved, list of ICD-10 codes that prove medical necessity for paravertebral facet joint injections. It is merely a guide to give you an idea of the types of diagnoses you might see with 64490 through +64495.

For a list of approved diagnosis codes for the 64490 through +64495 codes, consult with each payer individually.