Wiki Facet joint synovial cyst w/TFE at same level

[lcole7465]

We have a patient that the provider wants to do a facet joint synovial cyst and a TFE at the same level. Any input on what the CPT code(s) would be?

 

[jkyles]

Hi there, for Medicare you would report the cyst rupture/aspiration with the appropriate facet joint block code based on the level treated. Then you would report the appropriate transforaminal code for that level. I recommend checking your Facet Joint Intervention LCD. All LCDs contain the following statement:

It is not routinely necessary for multiple blocks (e.g., epidural injections, sympathetic blocks, trigger point injections, etc.) to be provided to a patient on the same day as facet joint procedures. Multiple blocks on the same day could lead to improper or lack of diagnosis. If performed, the medical necessity of each injection (at the same or a different level) must be clearly documented in the medical record. For example, the performance of both paravertebral facet joint procedures(s) and a transforaminal epidural injection (TFESI) at the same or close spinal level at the same encounter would not be expected unless a synovial cyst is compressing the nerve root. In this situation, TFESI may provide relief for the radicular pain, while the facet cyst rupture allows nerve root decompression. Frequent reporting of multiple blocks on the same day may trigger a focused medical review.

However, private payers have been following the MACs' lead for this policy.