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).
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 |
|
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: 12/07/2009
(SS/st)