FIRST COAST SERVICE OPTIONS
LOCAL COVERAGE DETERMINATION
CODING GUIDELINES
Contractor’s
Determination Number
64490
Contractor Name
First
Coast Service Options, Inc.
Contractor
Number
09102 –
09202 – Puerto Rico
09302 –
LCD Title
Paravertebral Facet Joint Blocks
Coding
Guidelines
Because
of the diagnostic nature of facet blocks, precise localization is
necessary. Therefore, it is expected
that use of the facet codes (CPT 64490-64495) would require radiologic
localization (i.e., fluoroscopy). Blocks performed without the use of fluoroscopy are considered
not medically necessary. Imaging guidance (fluoroscopy CT) and any injection of
contrast are inclusive components of 64490-64495 and not paid separately.
An injection may be
placed in the facet joint itself or around the medial branch nerve innervating
the joint. In general, it is believed
that two to three medial branch nerves innervate each lumbar facet joint and
two nerves innervate each cervical or thoracic facet joint. These nerves are the branches of the
posterior division of the spinal nerves, located immediately above and below
the joint. The CPT codes 64490 and 64493
are intended to be used to report all of the nerves that innervate the first level
paravertebral facet joint and not each nerve. Likewise, CPT codes 64491, 64492 and 64494,
64495 are intended to report second and third additional levels paravertebral facet joints and not each additional
nerve. Facet joint levels refer to the
joints that are blocked and not the number of medial branches that innervate
them as defined by the AMA CPT Committee.
Codes 64490-64495
are unilateral procedures. When bilateral injections are performed (e.g.,
injections performed at both the left and right paravertebral
facet joints), then the bilateral modifier 50 should be appended to the
appropriate code. Note that the multiple
procedures modifier 51 should not be appended to the add-on codes 64491, 64492,
64494 or 64495 because these are add-on codes and exempt from multiple procedure
concept.
The
cervical/thoracic facet injection codes (64490, 64491 and 64492) and
lumbar/sacral facet joint injection codes (64493, 64494 and 64495) are reported
once when the injection procedure is performed irrespective of whether a single
or multiple puncture is required to anesthetize the target joint at a given
level and side. To clarify, only one facet injection code should be reported at
a specific level and side injected (e.g., right L4-5 facet joint), regardless
of the number of needle(s) inserted or number of drug(s) injected at that
specific level.
Other Comments
V58.61 (Long-term
(current) use of anticoagulants) should be used only as a supplementary code in
addition to the primary diagnosis. This code should be reported when the use of
anticoagulants has been temporarily discontinued to facilitate multiple
interventional therapeutic modalities (e.g., facet joint blocks, trigger point
injections, lumbar sympathetic blocks) for pain management.
Revision History
|
Date |
Revision |
|
10/04/2011 |
2
- Added verbiage to
clarify the “Coding Guidelines” section of the LCD that fluoroscopy is an
inclusive component of CPT Codes 64490-64495 and not paid separately. The
revision is effective for claims processed on or after 10/04/2011 for dates
of service on or after 01/01/2010. |
|
01/01/2010 |
1 - Annual 2010 HCPCS
Update. Deleted CPT codes 64470,
64472, 64475 and 64476. Added CPT
codes 64490, 64491, 64492, 64493, 64494 and 64495. Deleted instructions regarding billing
codes for image guidance in addition to procedure codes for paravertebral injections (64490-64495). New 2010 HCPCS codes include image
guidance. Contractor Determination
Number was changed to 64490
The effective date of this revision is based on date of
service. |
|
02/02/2009 – |
Original |
Document formatted: 09/21/2011
(SSE/et)