Pain Management Coding Alert

Remember, not all payers have identical approved diagnoses.

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.

---