How To Use CPT Code 64490

CPT 64490 is a code used for injections in the paravertebral facet joint or nerves innervating that joint with image guidance in the cervical or thoracic region. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 64490 procedures.

1. What is CPT 64490?

CPT 64490 is a medical billing code used to describe a specific type of injection procedure performed on the paravertebral facet joint or nerves innervating that joint in the cervical or thoracic region. This procedure is typically performed to treat spinal pain or to identify the exact source of pain. The injections are administered with the assistance of image guidance, such as fluoroscopy or CT scans.

2. 64490 CPT code description

The official description of CPT code 64490 is: “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.”

3. Procedure

  1. The patient is prepped and anesthetized for the facet joint injection.
  2. The provider inserts the needle through the skin and advances it to the proper position within the joint using either fluoroscopy or CT imaging guidance.
  3. The therapeutic or diagnostic agent, such as a steroid or anesthetic mixture, is injected into the joint or nerves innervating the joint.
  4. The needle is removed, and the provider ensures that the site obtains hemostasis.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 64490 services are those experiencing spinal pain in the cervical or thoracic region that has not responded to conservative treatments, such as physical therapy or medication. The procedure may also be used for diagnostic purposes to identify the exact source of the pain. A thorough evaluation of the patient’s medical history, symptoms, and imaging studies should be conducted before determining if the procedure is appropriate.

5. When to use CPT code 64490

It is appropriate to bill the 64490 CPT code when a provider performs a single-level injection in the paravertebral facet joint or nerves innervating that joint in the cervical or thoracic region with image guidance. The procedure should be used to treat spinal pain or to identify the exact source of pain when conservative treatments have been unsuccessful.

6. Documentation requirements

To support a claim for CPT 64490, the following information should be documented in the patient’s medical record:

  • Patient’s medical history, including symptoms and previous treatments
  • Physical examination findings
  • Imaging studies, such as X-rays, MRI, or CT scans
  • Indication for the procedure, including the specific joint or nerve targeted
  • Details of the procedure, including the type of image guidance used, the agent injected, and the needle placement
  • Post-procedure findings, such as pain relief or diagnostic results

7. Billing guidelines

When billing for CPT code 64490, it is important to follow specific guidelines and rules. Do not separately code for multiple injections at the same spinal level. Report code 64490 once for the first level, for example, C3 to C4; report add-on code 64491 once for the second level, for example, C4 to C5; and report add-on code 64492 once for any additional levels. Imaging guidance, specifically fluoroscopy or CT, should not be separately reported.

8. Historical information

CPT 64490 was added to the Current Procedural Terminology system on January 1, 2010. There have been no updates to the code since its addition.

9. Similar codes to CPT 64490

There are several codes similar to CPT 64490, which differ based on the region of the spine and the number of levels injected. These include:

  • CPT 64491: This add-on code is used for the second level of injection in the cervical or thoracic region.
  • CPT 64492: This add-on code is used for any additional levels of injection in the cervical or thoracic region.
  • CPT 64493: This code is used for a single-level injection in the lumbar or sacral region.
  • CPT 64494: This add-on code is used for the second level of injection in the lumbar or sacral region.
  • CPT 64495: This add-on code is used for any additional levels of injection in the lumbar or sacral region.

10. Examples

  1. A patient with chronic neck pain undergoes a CPT 64490 procedure to inject a steroid into the C3-C4 facet joint using fluoroscopy guidance.
  2. A patient with thoracic spine pain receives a diagnostic injection of an anesthetic mixture into the T5-T6 facet joint using CT guidance, billed under CPT 64490.
  3. A patient with cervical radiculopathy undergoes a CPT 64490 procedure to inject a therapeutic agent into the nerves innervating the C6-C7 facet joint using fluoroscopy guidance.
  4. A patient with a history of failed conservative treatments for thoracic pain receives a CPT 64490 procedure to inject a steroid into the T7-T8 facet joint using CT guidance.
  5. A patient with cervical spondylosis undergoes a CPT 64490 procedure to inject a diagnostic agent into the C4-C5 facet joint using fluoroscopy guidance.
  6. A patient with thoracic facet joint syndrome receives a CPT 64490 procedure to inject a therapeutic agent into the T9-T10 facet joint using CT guidance.
  7. A patient with cervical spinal stenosis undergoes a CPT 64490 procedure to inject a steroid into the C5-C6 facet joint using fluoroscopy guidance.
  8. A patient with thoracic degenerative disc disease receives a CPT 64490 procedure to inject a diagnostic agent into the T11-T12 facet joint using CT guidance.
  9. A patient with cervical osteoarthritis undergoes a CPT 64490 procedure to inject a therapeutic agent into the C7-T1 facet joint using fluoroscopy guidance.
  10. A patient with thoracic myofascial pain syndrome receives a CPT 64490 procedure to inject a steroid into the T3-T4 facet joint using CT guidance.

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