Neurosurgery Coding Alert

Answer: You will report code 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) for intra-articular facet injection at C2-C3. The code descriptor specifies ‘per level’ implying that you report one unit for each level. You report a single unit of 64490 as C2-C3 is a single level. Include modifier RT (Right side) since your physician injected the nerve on the right side. 

 

Your surgeon did the C2-C3 facet joint injection with a purpose of blocking the third occipital nerve fibers innervating the facet joint. Therefore, you typically submit only code 64490.  You do not need to append modifier 22 (Increased procedural service) in this case as there isn’t any additional work involved based on the location. 

 

The purpose of the facet joint injection is to block the third occipital nerve (TON) as this nerve is a superficial medial branch of the dorsal ramus of C3 spinal nerve. It innervates the C2-3 facet joint as well as some of the muscles in the neck and back of the head. Pain originating from pathology in this joint can be referred to the occiput and even anteriorly to the frontal region and orbit.