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These Diagnoses Might Mean Facet Joint Injection
Published on Fri May 18, 2018
Payer policies will differ for these services.
When a patient reports to the PM specialist for a paravertebral facet joint injection in the cervical/thoracic or lumbar/sacral areas, you'll report the service with one or more of the following codes, depending on encounter specifics:
- 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)
- +64491 - ... second level (List separately in addition to code for primary procedure)
- + 64492 - ... 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 (fluoroscopy or CT), lumbar or sacral; single level
- +64494 - ... second level (List separately in addition to code for primary procedure)
- + 64495 - ... third and any additional level(s) (List separately in addition to code for primary procedure).
While there is no single source of approved diagnosis codes for these injections, there are a few that are commonly attached to one or more of the above codes. Those ICD-10 codes include:
- M25.511 - Pain in right shoulder
- M25.512 - Pain in left shoulder
- M25.521 - Pain in right elbow
- M25.522 - Pain in left elbow
- M25.531 - Pain in right wrist
- M25.532 - Pain in left wrist
- M25.551 - Pain in right hip
- M25.552 - Pain in left hip
- M25.571 - Pain in right ankle and joints of right foot
- M25.572 - Pain in left ankle and joints of left foot
- M47.14 - Other spondylosis with myelopathy, thoracic region
- M47.812 - Spondylosis without myelopathy or radiculopathy, cervical region
- M47.817 - Spondylosis without myelopathy or radiculopathy, lumbosacral region
- M47.892 - Other spondylosis, cervical region
- M47.897 - Other spondylosis, lumbosacral region
- M47.9 - Spondylosis, unspecified
- M54.2 - Cervicalgia
- M54.5 - Low back pain
- M96.1 - Postlaminectomy syndrome, not elsewhere classified.
Remember: This is not a complete, or approved, list of ICD-10 codes that prove medical necessity for paravertebral facet joint injections. It is merely a guide to give you an idea of the types of diagnoses you might see with 64490 through +64495.
For a list of approved diagnosis codes for the 64490 through +64495 codes, consult with each payer individually.