CPT® Code 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

Paravertebral facet joints, also known as zygapophyseal joints, are critical structures located on the posterior aspect of the spine, situated on either side of the vertebrae 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 due to destabilization of the spinal joints, formation of scar tissue, or recurrence of disc herniation. Other potential causes of facet joint pain include degenerative conditions such as spondylosis, spondylolisthesis, and arthritis. The procedure associated with CPT® Code 64490 involves the injection of a diagnostic or therapeutic agent into the paravertebral facet joint or the nerves that innervate that joint, utilizing image guidance through fluoroscopy or computed tomography (CT). This process begins with the preparation of the skin over the facet joint, followed by the administration of a local anesthetic. A spinal needle is then carefully directed into the facet joint space until it encounters bone or cartilage. To confirm the correct positioning of the needle, a small amount of contrast material is injected. Subsequently, a local anesthetic and/or steroid is administered. The diagnostic facet joint injection aims to identify the specific source of pain by using a local anesthetic. 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 billing purposes, CPT® Code 64490 is designated for a single cervical or thoracic facet joint injection, while codes 64491 and 64492 are used for additional levels injected.