Highlights
Facet Paravertebral
Joint Nerve Block
Injections for Pain
Management Coding
and Billing
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Facet Paravertebral Joint Nerve Block Injections for Pain Management
Coding and Billing

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; first level (List
separately in addition to code for primary procedure)

+64491 Injection(s), diagnostic or therapeutic agent, paravertebral
facet (zygapophyseal) joint (or nerves innervating that joint)
with image
guidance
(fluoroscopy or CT), cervical or thoracic; second level (List
separately in addition to code for primary procedure)

+64492 Injection(s), diagnostic or therapeutic agent, paravertebral
facet (zygapophyseal) joint (or nerves innervating that joint)
with image
guidance
(fluoroscopy or CT), 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

64494 Injection(s), diagnostic or therapeutic agent, paravertebral facet
(zygapophyseal) joint (or nerves innervating that joint)
with image
guidance
(fluoroscopy or CT), lumbar or sacral; second level (List
separately in addition to code for primary procedure)

+64495 Injection(s), diagnostic or therapeutic agent, paravertebral
facet (zygapophyseal) joint (or nerves innervating that joint)
with image
guidance
(fluoroscopy or CT), lumbar or sacral; third and any additional
level(s) (List separately in addition to code for primary procedure)

Keypoints:

1. These codes additionally describes zygapophyseal joint or the nerves
innervating that joint;
2. These codes is inclusive with image guidance; eg. fluoroscopy or CT;
3. These codes requires Imaging and Localization for proper needle
placement;
4. If imaging is NOT used, report using 20550-20553 or 64999 if
ultrasound guidance is used.
5. Append modifier 50 for bilateral procedures.
6. These codes are already on Medicare's 2010 Fee Schedule.

source: CPT changes Insider's View 2010, CPT Book for 2010, Medicare Website www.cms.gov