Anesthesia Coding Alert

Question: The physician advanced a 25 gauge spinal needle into the posterior aspect of the right T12-L1 facet joint. Needle aspiration was found to be negative for blood or cerebrospinal fluid (CSF). O.25 cc of Isovue 200 was then injected into the facet joint confirming an intra-articular facet joint placement. He then injected 1 cc of 4% Lidocaine and 0.5 cc of Depo-Medrol 80 mg/ml into the joint. How should we code this procedure?

New Hampshire Subscriber

Answer: The correct choice for injections to the T12-L1 joint or nerves innervating that joint is 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). Providers must use image guidance to complete the procedure, but you don't report it separately because the descriptor states, "with image guidance."

Explanation: CPT^® parenthetical notes changed in 2011 to direct providers to report the cervical/thoracic choice for a T12-L1 facet injection rather than the lumbar/sacral facet joint injection code.