AMA CPT Assistant July 2011
Question: What is the correct coding for aspiration of a synovial cyst of the facet joints?
Answer: There is no specific code for the insufflation and aspiration of a synovial cyst at a facet joint. Therefore, code 64999, Unlisted procedure, nervous system, may be reported to represent this procedure. If fluoroscopic guidance is used, it may be additionally reported with code 77003, Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, subarachnoid, or sacroiliac joint), including neurolytic agent destruction....
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Although AMA CPT Assistant describes using an unlisted code, I don't believe the carrier is going to paid facet cyst aspiration in addition to the injection. If the patient was receiving a diagnostic or therapeutic facet injection during the same session, the facet cyst might be considered inclusive to the injection code 64493 since it includes multiple needle placement under one code.