Eli's Rehab Report

Question: I need help with the following procedure: Fluoroscopically directed injection of pseudoarthrosis L5-S1; a 22-gauge needle was guided into the pseudoarthrosis after 1 percent xylocaine used for anesthesia, 5 cc of 0.5 percent marcaine, and injected  40 mg Depo-Medrol.


North Dakota Subscriber


Answer: Pseudoarthrosis is literally a "false joint," a painful contact between two bones that develops at the site of a failed fusion. Patients typically present with a history of spinal fusion and signs of instability. X-rays of these patients may show motion and, in essence, non-fused bone sites. The x-rays will also show movement and instability at the site.

You should ask your provider if he injected into the L5-S1 facet joint or at the point of the spinal fusion hardware (if present). Spinal surgeons often ask pain providers to do an injection into the fusion area or on the pedicle screws to help diagnose where the patient's continued pain is generated from before they proceed with a huge revision surgery.

The answers will lead you to the correct procedure code. Possible CPT choices are 64475 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, single level) or CPT 64999 (Unlisted procedure, nervous system).