CPT® Code 64470

Deleted Code, see 64490-64495.

Official Description

Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level

Common Language Description

A paravertebral facet joint or facet joint nerve injection involves the administration of an anesthetic agent and/or steroid into the facet joint or its associated nerve. Facet joints are small joints located at the back (posterior) of the spine, situated on either side of the vertebrae where one vertebra overlaps another. These joints play a crucial role in providing stability and facilitating movement in the spine. Pain originating from these joints can arise from various conditions, including post laminectomy syndrome, which may occur after spinal surgery due to destabilization of the spinal joints, formation of scar tissue, or recurrent disc herniation. Other potential causes of facet joint pain include spondylosis, a degenerative condition affecting the spine, spondylolisthesis, where a vertebra slips out of place, and arthritis, which can lead to inflammation and pain in the joints. During the procedure, fluoroscopic guidance may be utilized to ensure accurate placement of the injection. Initially, the skin over the facet joint is prepared, and a local anesthetic is administered to minimize discomfort. A spinal needle is then carefully directed into the facet joint space until it encounters bone or cartilage. To confirm correct needle positioning, a small amount of contrast material is injected. Following this verification, a local anesthetic and/or steroid is injected into the joint. The diagnostic facet joint injection primarily uses a local anesthetic to help identify the specific area responsible for the patient's pain. If the patient experiences significant pain relief after this diagnostic injection, a therapeutic injection may be performed on a subsequent date, utilizing a long-acting local anesthetic combined with a steroid for more prolonged relief. For coding purposes, CPT® Code 64470 is used for a single cervical or thoracic facet joint injection, while 64472 is designated for each additional cervical or thoracic level injected. Similarly, 64475 is used for a single lumbar or sacral facet joint injection, with 64476 for each additional lumbar or sacral level injected.

1. Indications

Facet joint injections are indicated for various conditions that cause pain in the cervical or thoracic regions of the spine. The following are explicitly provided indications for this procedure:

Post Laminectomy Syndrome - Pain that persists following spinal surgery due to destabilization of spinal joints or scar tissue formation.
Recurrent Disc Herniation - Pain resulting from the reoccurrence of a herniated disc affecting the spinal nerves.
Spondylosis - A degenerative condition of the spine that can lead to pain and discomfort in the facet joints.
Spondylolisthesis - A condition where one vertebra slips over another, potentially causing pain in the facet joints.
Arthritis - Inflammation of the facet joints that can lead to chronic pain and reduced mobility.

2. Procedure

The procedure for a paravertebral facet joint injection involves several critical steps to ensure accuracy and effectiveness. The following procedural steps are outlined:

Step 1: Preparation - The skin over the targeted facet joint is thoroughly cleaned and prepped to minimize the risk of infection. A local anesthetic is then injected into the skin to numb the area, ensuring patient comfort during the procedure.
Step 2: Needle Insertion - A spinal needle is carefully directed into the facet joint space. The physician advances the needle until it encounters bone or cartilage, which indicates that the needle is in the correct position.
Step 3: Contrast Injection - To confirm the accurate placement of the needle, a small amount of contrast material is injected. This step is crucial as it allows the physician to visualize the needle's position within the joint space using fluoroscopic guidance.
Step 4: Injection of Anesthetic and/or Steroid - Once the needle position is verified, a local anesthetic and/or steroid is injected into the facet joint. The local anesthetic provides immediate pain relief, while the steroid helps reduce inflammation and provides longer-lasting relief.
Step 5: Post-Injection Monitoring - After the injection, the patient is monitored for any immediate adverse reactions and to assess the effectiveness of the procedure. If the patient experiences significant pain relief, a therapeutic injection may be scheduled for a later date.

3. Post-Procedure

Following the facet joint injection, patients are typically advised to rest and avoid strenuous activities for a short period. They may experience some soreness at the injection site, which is generally mild and temporary. Patients are often monitored for any immediate side effects, and instructions regarding pain management and activity restrictions are provided. If the injection is successful, patients may experience significant pain relief, which can last for days to weeks, depending on the individual and the specific treatment administered. Follow-up appointments may be scheduled to evaluate the effectiveness of the injection and to determine if further therapeutic injections are necessary.

Short Descr	INJ PARAVERTEBRAL C/T
Medium Descr	INJ PARAVERTEBRAL C/T
Long Descr	NJX ANES&/STRD JT NRV CRV/THRC 1 LVL
APC Status Indicator	Significant Procedure, Multiple Reduction Applies
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	none
MUE	Not applicable/unspecified.
CCS Clinical Classification	5 - Insertion of catheter or spinal stimulator and injection into spinal canal