CPT® Code 0218T

Add-On Code

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure)

Paravertebral facet joints, also known as zygapophyseal joints, are critical structures located at the posterior aspect of the spine, situated on either side of each vertebra where one vertebra overlaps another. These joints play a significant role in spinal movement and stability. Pain originating from these joints can be attributed to various conditions, including post-laminectomy syndrome, which may arise after spinal surgery that destabilizes the joints, leading to scar tissue formation or recurrent disc herniation. Other potential causes of facet joint pain include degenerative conditions such as spondylosis, spondylolisthesis, and arthritis. The procedure described by CPT® Code 0218T involves the injection of a diagnostic or therapeutic agent into the paravertebral facet joint or the nerves that innervate that joint, utilizing ultrasound guidance to ensure precise placement. This process begins with the preparation of the skin over the facet joint, followed by the administration of a local anesthetic to minimize discomfort. A spinal needle is then carefully directed into the facet joint space until it encounters bone or cartilage, at which point a small amount of contrast material is injected to confirm the correct positioning of the needle. Subsequently, a local anesthetic and/or steroid is injected to provide pain relief. The diagnostic facet joint injection aims to identify the specific source of pain, and if significant relief is achieved, a therapeutic injection may be performed later using a long-acting local anesthetic combined with a steroid. For coding purposes, CPT® Code 0218T is specifically designated for the third and any additional lumbar or sacral facet joint injections, following the primary procedure codes for the first and second levels.