Orthopedic Coding Alert

Question: For a patient who is diagnosed with lumbar pars defect, can we report code 64493 for a lumbar pars injection? Is this the correct CPT® code?  

North Carolina Subscriber 

Answer: You are correct to report code 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) for lumbar pars injection. 

Why 64493? The pars interarticularis is the segment of vertebral bone that joins the superior and inferior articular facets. Because of this location, a pars defect injection technique is similar to a facet joint injection. Many providers report the procedure as a facet joint injection, with 64493. 

Diagnosis choices: A pars defect may be congenital (756.11, Congenital spondylolysis, lumbosacral region) or due to trauma, stress, or sports injuries (738.4, Acquired spondylolisthesis). Private payers might accept both of these diagnoses – along with many others – with 64493. The Medicare local coverage determination (LCD), however, only lists 738.4 as supporting medical necessity for 64493. Verify the patient’s situation so you can choose the most accurate diagnosis code that supports medical necessity.

ICD-10: When your diagnosis system changes, 756.11 will become Q76.2 (Congenital spondylolisthesis). Code 738.4 will expand to numerous codes in the M43.0- (Spondylolysis) and M43.1- (Spondylolisthesis) categories. Your fifth digit will depend on the anatomic location.