CPT® Code 64491

Add-On Code

Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level (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 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 64491 involves the injection of a diagnostic or therapeutic agent into the paravertebral facet joint or the nerves that innervate that joint, utilizing image guidance techniques such as 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 to minimize discomfort. A spinal needle is then carefully directed into the facet joint space until it encounters bone or cartilage, ensuring accurate placement. 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 to provide pain relief or to assist in diagnosing the source of pain. The initial injection, known as a diagnostic facet joint injection, utilizes a local anesthetic to pinpoint the specific area responsible for the patient's pain. If the patient experiences significant pain relief following this diagnostic injection, a therapeutic injection may be performed on a subsequent date, which typically involves a long-acting local anesthetic combined with a steroid. It is important to note that CPT® Code 64490 is used for a single cervical or thoracic facet joint injection, while CPT® Code 64491 is designated for the second level, and CPT® Code 64492 is applicable for the third and any additional cervical or thoracic levels injected.