DRAFTv.2FIRST COAST SERVICE OPTIONS
LOCAL COVERAGE DETERMINATION
CODING GUIDELINES
LCD Number
64470
Contractor
Name
First Coast Service
Options, Inc.
Contractor
Number
09102 – Florida
09202 – Puerto Rico
09302 – Virgin Islands
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 64470, 64472, 64475 and 64476) would require radiologic
localization (i.e., fluoroscopy).
Effective 01/01/2007,
use CPT code 77003 for the fluoroscopic guidance of the needle. Note that this code is defined as “for
injection procedures” (plural), and so it may be billed only once regardless of
the number of levels addressed. Codes
77001, 77002 and 77003 were established effective 01/01/2007 to replace codes
75998, 76003, and 76005, respectively.
Effective,
01/01/2007, use CPT code 77012 for the computerized tomography guidance for
needle placement, (e.g., biopsy, aspiration, injection, localization device),
radiological supervision and interpretation.
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 64470 and
64475 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 64472 and 64476 are
intended to report each additional level paravertebral facet joint 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 64470-64476
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 64472 or 64476 because these are
add-on codes and exempt from multiple procedure concept.
The
cervical/thoracic facet injection codes (64470 and 64472) and lumbar/sacral
facet joint injection codes (64475 and 64476) 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 |
|
02/02/2009 –
Florida |
Original |
Document formatted:
01/03/2008 (CH/st)