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
The code descriptor is plural with multiple injections that can occur for a given facet level on a single side or bilateral with modifier 50 but only one code is report per level treated (first level, second level, third & any addl.) , below is from past AMA CPT Assistants in which they describe facet joint injections in conjunction with medial branch blocks at the same level as being reported per level with no additional reporting for multiple techniques utilized at that level.
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AMA CPT Assistant
May 2004 page 15
Coding Consultation:Questions and Answers
Nervous System, 64475 (Q&A)
Question
The physician is performing multiple injections in L4-5. He is performing a medial branch lumbar facet nerve block, as well as facet steroid injections. He initially inserts a needle to a depth of 1.2 mm within the facet joint. He then injects Depo-Medrol into each facet joint (L3-4, L4-5, L5-S1) and removes the needles completely. Following this, the physician inserts another set of needles, this time to the tar points until the bone is reached in order to complete the nerve block. At this juncture, Marcaine is being injected, and once again the needles are withdrawn. Should code 64475 be reported more than one time for each injection?
AMA Comment
From a CPT coding perspective, code 64475, Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, single level, should be reported only one time for a facet injection at a specified level and side, regardless of the number of times the physician is sticking the needle at the same level. Therefore, it would not be appropriate to report code 64475 more than one time at the same level.
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AMA CPT Assistant
Rationale
September 2004 page 1
The Facets of Paravertebral Facet Joint Procedures (64470-64476, 64622-64627)
Example 3
The physician is performing medial branch lumbar facet nerve blocks as well as facet joint steroid injections using fluoroscopic localization (without contrast material). In performing this procedure, a needle is initially inserted within each facet joint. Then a steroidal agent is injected into each right sided facet joints of L3-4, L4-5, L5-S1 and the needles are completely removed. Another set of needles are inserted, this time targeting the medial branch nerves supplying the aforementioned joints (L2, L3, L4, L5). An anesthetic agent is injected over each of these medial branch nerves and once again the needles are removed.
In this example, the facet injection codes 64475 and 64476 represent unilateral procedures reported once for injection(s) at a specific level regardless of the number of needle(s) inserted or number of drug(s) injected. Therefore, for this specific intervention, the following codes should be reported:
Code 64475, Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, single level, to describe the unilateral injections performed at L3-L4.
Code 64476, Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, each additional level (List separately in addition to code for primary procedure), to describe the unilateral injections performed at L4-L5.
Code 64476, Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, each additional level (List separately in addition to code for primary procedure, to describe the unilateral injections performed at L5-S1.
