How To Use CPT Code 64451

CPT 64451 describes the injection of anesthetic agent(s) and/or steroid into the nerves innervating the sacroiliac joint, with image guidance. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 64451?

CPT 64451 is used to describe the injection of anesthetic agent(s) and/or steroid into the nerves that supply the sacroiliac joint. This procedure is performed under image guidance, such as fluoroscopy or computed tomography (CT). It is used for both diagnostic and therapeutic purposes to diagnose and/or treat sacroiliac joint pain.

2. Official Description

The official description of CPT code 64451 is: ‘Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography).’ It is important to note that this code should not be reported in conjunction with codes 64493, 64494, 64495, 77002, 77003, 77012, 95873, or 95874. For injections using ultrasound guidance, CPT code 76999 should be used. If the procedure is performed bilaterally, modifier 50 should be appended to the code.

3. Procedure

1. The provider prepares the patient by administering anxiolytics to reduce anxiety.
2. The patient is positioned in the modified Sims position, either prone or lateral with the pelvis rotated to clearly visualize the sacroiliac joint under fluoroscopic or CT imaging guidance.
3. The provider inserts a 22-gauge spinal needle into the inferior aspect of the sacroiliac joint, advancing it through the skin, joint capsule, and ligaments until it reaches the joint.
4. Contrast is injected through the needle to outline the joint and confirm the needle’s position.
5. The patient is asked if they feel any pain and if it is the typical pain they usually experience.
6. Once the needle’s location is confirmed, the provider injects anesthetic agents (such as lidocaine or bupivacaine) and/or corticosteroids (anti-inflammatory agents) into the joint.
7. The patient’s pain relief is assessed, and if the pain is relieved, the procedure can be considered confirmatory for sacroiliac joint pain. If the pain is not relieved, other potential sources of pain may be investigated.
8. The needle is withdrawn, and an adhesive bandage is placed over the injection site.

4. Qualifying circumstances

CPT 64451 is performed on patients experiencing sacroiliac joint pain. It is used to both diagnose and treat this type of pain. The procedure is typically performed after the patient has been given anxiolytics to reduce anxiety. The provider must use image guidance, such as fluoroscopy or CT, to ensure accurate needle placement. Anesthetic agents, such as lidocaine or bupivacaine, and/or corticosteroids are injected into the nerves supplying the sacroiliac joint to provide pain relief and reduce inflammation.

5. When to use CPT code 64451

CPT code 64451 should be used when the provider performs an injection of anesthetic agent(s) and/or steroid into the nerves innervating the sacroiliac joint under image guidance. This code is appropriate for both diagnostic and therapeutic purposes. It should not be reported in conjunction with codes 64493, 64494, 64495, 77002, 77003, 77012, 95873, or 95874. For injections using ultrasound guidance, CPT code 76999 should be used. Modifier 50 should be appended to the code if the procedure is performed bilaterally.

6. Documentation requirements

To support a claim for CPT code 64451, the provider must document the following information:

• Patient’s diagnosis or indication for the procedure
• Use of image guidance (fluoroscopy or CT)
• Specific nerves targeted for injection
• Type and amount of anesthetic agent(s) and/or steroid used
• Confirmation of needle position through contrast injection
• Patient’s response to the injection (pain relief or lack thereof)
• Procedure start and end time
• Signature of the performing provider

7. Billing guidelines

When billing for CPT code 64451, it is important to ensure that the procedure meets the necessary criteria. The injection should be performed by a qualified provider and should involve the nerves innervating the sacroiliac joint. Image guidance, such as fluoroscopy or CT, should be used during the procedure. It is also important to note that CPT code 64451 should not be reported in conjunction with codes 64493, 64494, 64495, 77002, 77003, 77012, 95873, or 95874. Modifier 50 should be appended to the code if the procedure is performed bilaterally.

8. Historical information

CPT code 64451 was added to the Current Procedural Terminology system on January 1, 2020. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient presents with chronic sacroiliac joint pain. The provider performs CPT code 64451, injecting anesthetic agents and corticosteroids into the nerves supplying the joint under fluoroscopic guidance. The patient experiences significant pain relief, confirming the diagnosis of sacroiliac joint pain.