Coding intra-articular facet joint injections

Intra-articular facet joint injections are represented in CPT by the code series 64490-64495. This code series include imaging guidance of fluoroscopy and  CT.  These codes also include any diagnostic or therapeutic agents  (anesthetic agent, cortisone) used in the injections. This code series represent unilateral services and to report bilateral service 50 modifier should be appended to the codes including add on codes. If unilateral service is performed then LT or RT modifiers should be appended to the codes.

EXAMPLE:

PREOPERATIVE DIAGNOSIS:
1. Left lumbar facet arthropathy.
2. Lumbar spondylosis with disk degeneration.

POSTOPERATWE DIAGNOSIS:
As above.

OPERATION PERFORME:
1. Left L4-5 and L5-S 1 intra-articular facet joint injection under fluoroscopy. Anesthetic agent for analgesia and steriods were used for the injection.
2. Left L3 and LA medial branch block under fluoroscopy.
3. Left L5 dorsal rami block under fluoroscopy.

COMPLICATIONS: None.

DX   CODE   DESCRIPTION  
1     721.3 Lumbosacral Spondylosis w/o Myelopathy
2     722.52 Disc Degeneration Lumbar/Lumbosacral

PX   CODE   DESCRIPTION  
1     03.92    Injection Agent NEC Into Spinal Canal  
2     03.91    Injection Anesthetic Spinal Canal For Analgesia  
3     99.23    Injection of Steroid  

CPT  CODE   DESCRIPTION                   Modifier     
1     64493 Facet Joint Injection Lumbar           LT 

                  Single Level
2     64494 Facet Joint Injection Lumbar           LT  

                  Second Level