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Thread: 64420 vs 64490 battle of the codes

  1. #1

    Default 64420 vs 64490 battle of the codes

    AAPC: Back to School
    Hi all,

    64470 was replaced with 64490 in 2010, now including fluoroscopy. But if fluoroscopy is not performed, should we go with 64420?

    Going round and round with one of our docs, so any help is good help.


  2. #2


    per CPT book, it states Image guidance (fluoroscopy or CT) and any injection of contrast are inclusive components of 64490-64495. Imaging guidance and localization are required for the performance of paravertebral facet joint injections described by codes 64490-64495. If imaging guidance is not used, report 20550-20553. If ultrasound guidance is used report 64999 or 0213T-0218T. Hopefully you can show him the CPT book and point this out about 20550-20553.

    Good luck!
    Susan, CPC-H

  3. #3


    (These are my opinions and should not be construed as being the final authority. Other opinions may vary.)

    The advice above is good. Also, please read the Medicare LCD for your locality. Two that I found (we code for various locations) state; "For the procedure, we require that a needle is placed in the proper position under fluoroscopic guidance since correct anatomic placement is essential. Procedures performed without fluoroscopic guidance are considered a trigger point injection." Other LCDs state that a Facet Injection without fluoro will be denied as not medically necessary. But how would they know fluoro was not used since it is an inclusive part of the procedure and not coded?

    Richard Mann, your pain management coder

  4. #4


    thanks, yeah, we've gone around about the 20550 code, the crux being that's not really what they're doing. We'll probably end up using the cat iii codes.

  5. #5
    Join Date
    Apr 2007
    Denver Colorado


    Remember though the category III codes require the use of ultrasound for needle guidance. They are not to be used when the provider doesn't use any radiologic imaging to perform the facet joint injections. When the facet joint injections are performed "blind" or "anatomically guided", CPT directs providers to report with a code from the 20550 - 20553 code range.

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