CPT® Code 64492

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; 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 the vertebrae where one vertebra overlaps another. These joints play a significant role in spinal movement and stability. Pain in the facet joints can arise from various conditions, including post-laminectomy syndrome, which may occur after spinal surgery due to destabilization of the spinal joints, the formation of scar tissue, or recurrent disc herniation. Other potential causes of facet joint pain include degenerative conditions such as spondylosis, spondylolisthesis, and arthritis. To address this pain, a procedure involving the injection of a diagnostic or therapeutic agent into the facet joint or the nerves that innervate the joint is performed. This procedure is conducted with the aid of imaging guidance, either fluoroscopy or computed tomography (CT), to ensure accurate placement of the injection. Initially, the skin over the facet joint is sterilized, and a local anesthetic is administered to minimize discomfort. A spinal needle is then carefully directed into the facet joint space until it contacts bone or cartilage. To confirm the correct positioning of the needle, 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 utilizes a local anesthetic to pinpoint the specific source of pain. If the patient experiences significant pain relief after this diagnostic injection, a therapeutic injection may be scheduled for a later date, which typically involves a long-acting local anesthetic combined with a steroid. For coding purposes, CPT® Code 64490 is used for a single cervical or thoracic facet joint injection, 64491 for the second level, and 64492 for the third and any additional cervical or thoracic levels injected.