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Pain
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Coding

FACET JOINT
BLOCK
INJECTION
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  • Each facet joint is supplied by two nerves.
  • A facet joint block can be performed by injecting into the joint or
    nerves is called medial branch blocks or facet joint nerve blocks.
  • The nerves that cause the pain in the facet joints are called the
    medial branches of the dorsal rami of the spinal nerves. Thus,
    necessary to block two medial branches for each facet joint.
  • These blocks can be performed for the diagnosis of the pain coming
    from the facet joints or for the treatment of the pain coming from the
    facet joints.  ~ source: http://www.thepainmd.com/2_04FacetJntInject.
    html

Inclusive of CPT Code 77003 - Fluoroscopic guidance and localization of
needle or catheter tip for spine or paraspinous diagnostic or therapeutic
injection procedures. (Effective January 01, 2010).

Rationale: This nerve injection is performed under fluoroscopic guidance
for precise anatomic site localization to avoid injury to the vertebral
artery, spinal cord or surrounding areas.

CPT Code 77012 - Computed tomography guidance for needle placement
(eg, biopsy, aspiration, injection, localization device), radiological
supervision and interpretation. (inclusive with the primary procedure
effective January 01, 2010)


Here are your CPT Codes:

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         cervical or thoracic; second level (List separately in addition to
code for primary procedure)

64492         cervical or thoracic; 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         lumbar or sacral; second level (List separately in addition to
code for primary procedure)

64495         lumbar or sacral; third and any additional level(s) (List
separately in addition to code for primary procedure)

According to the American Medical Association published
newsletter, the CPT Assistant in September 2004:

“The paravertebral facet joint injection codes should be reported per
spinal level. Each vertebra in the spine is joined to the one above and
the one below it by articular facet joints.”
It further says; “ each facet joint has dual innervation; one from the dorsal
rami at the same level and one from the level above (eg. The L4-L5
lumbar facet joint is innervated by the medial branches of the dorsal rami
from L3 and L4)”


The above guideline remained unchanged until today the 30th of
September 2012

Pain Management Coding

Example: Lumbar Facet Joint

Nerve Block at L2/L3 and L3/L4 joints.

Let’s do the CODING!

64493 x 1 (L2/L3) – (L2 Medial Branch; L3 Pedicle)

64494 x 1 (L3/L4) – (L3 Medial Branch; L4 Pedicle)

77003 (Fluoro Guidance) included!

Pain Management Coding TIPS:

Facet Nerve Blocks are coded per spinal level.
One more example:

Pain specialist is focusing on 4 nerves at L1, L2, L3, L4.
Code this as:
64493 x 1 unit
64494 x 1 unit
64495 x 1 unit


REMEMBER FOR YOUR “ADD-ON” CODES:
(64491, 64492, 64494, 64495)

     They are not stand-alone codes!
     Modifier -51 is not allowed

Your codes are:

Unilateral ( Modifier LT, RT)

Bilateral Modifier (-50)

GLOBAL Days  0

Image Guidance is included with your codes!


Referencences:  CPT Changes 2012, CPT Code Book 2012.

**** For more references: Consult your CPT code books. The National Correct Coding Initiative (NCCI) and third pary payer payment policies and
guidelines

Disclaimer:  CPT is owned, mantained and is a registered
trademark of the American Medical Association


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