How To Use CPT Code 64492

CPT 64492 describes the injection of a diagnostic or therapeutic agent into the paravertebral facet joint or the nerves innervating that joint at the cervical or thoracic level, using imaging guidance such as fluoroscopy or CT scan. 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 64492?

CPT 64492 is used to describe the injection of a diagnostic or therapeutic agent into the paravertebral facet joint or the nerves innervating that joint at the cervical or thoracic level. This procedure is performed by a healthcare provider using imaging guidance, such as fluoroscopy or CT scan, to ensure accurate placement of the injection. The goal of this procedure is to treat spinal pain or identify the exact source of pain.

2. Official Description

The official description of CPT code 64492 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; third and any additional level(s) (List separately in addition to code for primary procedure).’ This code should be used in conjunction with CPT codes 64490 and 64491 for the initial levels of injection.

3. Procedure

1. The healthcare provider administers facet injections at two initial spinal levels using imaging guidance.
2. If necessary, the provider preps and anesthetizes the patient for the third and any additional level facet joint injections during the same session.
3. The provider inserts a needle through the skin and advances it to the proper position within the joint using fluoroscopy or CT imaging guidance.
4. A diagnostic or therapeutic agent, such as a steroid or anesthetic mixture, is injected into the joint or the nerves innervating the joint.
5. The provider removes the needle and ensures that the injection site achieves hemostasis.

4. Qualifying circumstances

CPT 64492 is performed on patients who require diagnostic or therapeutic injections into the paravertebral facet joint or the nerves innervating that joint at the cervical or thoracic level. This procedure is typically used to treat spinal pain or identify the exact source of pain. The injections are performed by a healthcare provider using imaging guidance, such as fluoroscopy or CT scan, to ensure accurate placement of the injection.

5. When to use CPT code 64492

CPT code 64492 should be used when a healthcare provider performs injections into the paravertebral facet joint or the nerves innervating that joint at the cervical or thoracic level, using imaging guidance such as fluoroscopy or CT scan. This code should be used for the third and any additional levels of injection, in addition to the primary procedure codes 64490 and 64491. It is important to note that CPT code 64492 should not be reported more than once per day.

6. Documentation requirements

To support a claim for CPT code 64492, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for paravertebral facet joint injections
• Imaging guidance used, such as fluoroscopy or CT scan
• Date and time of the procedure
• Specific levels of injection performed
• Type and amount of diagnostic or therapeutic agent injected
• Confirmation of hemostasis at the injection site

7. Billing guidelines

When billing for CPT code 64492, it is important to ensure that the procedure is performed by a qualified healthcare provider and that imaging guidance, such as fluoroscopy or CT scan, is used. This code should be reported in addition to the primary procedure codes 64490 and 64491 for the initial levels of injection. It is not necessary to separately report imaging guidance. Additionally, CPT code 64492 should not be reported more than once per day.

8. Historical information

CPT code 64492 was added to the Current Procedural Terminology system on January 1, 2010. There have been no updates to the code since its addition.

9. Examples

1. A healthcare provider performs a diagnostic injection into the paravertebral facet joint at the cervical level using fluoroscopy guidance to identify the source of a patient’s neck pain.
2. Using CT scan guidance, a provider administers a therapeutic injection into the nerves innervating the paravertebral facet joint at the thoracic level to alleviate a patient’s mid-back pain.