CPT code 64493

(2022) CPT Code 64493 – Description, Billing Guidelines, Modifiers, Reimbursement

CPT code 64493 defines injections of diagnostic or therapeutic agents into the paravertebral Facet joint or nerves under imaging guidance lumbar or sacral; a single level. CPT 64494 refers to the “second level (list separately in addition to code for the main action).” 

CPT Code 64493 Description

A facet joint block is used to diagnose and treat paravertebral Facet joint pain. Facet joint pain syndrome is a difficult diagnosis to make since there is no detailed history, physical examination finding, or radiological imaging evidence. 

This is a possible diagnosis if the patient has aching, non-specific back pain that extends into the paravertebral portion of the spinal column. All patients should have a thorough evaluation of the spine.

 For patients with chronic back pain, radiological imaging is often used to rule out other conditions. Facet joint block is one way to record and corroborate concerns regarding posterior fundamental biomechanical back discomfort.

Anesthetic medicines injected into the facet joint capsule and the ligament joint capsule around it numb the common during diagnostic and therapeutic procedures called Facet joint injections. If the facet joints become inflamed, they may cause discomfort in various places, such as the back, neck, and shoulders.

 Facet joints in the lumbar and thoracic spine may cause back, hip, buttock, and leg pain. The injection of medication into the joint should alleviate pain and assist in determining whether or not the joint is the source of the patient’s discomfort. 

Pain relief is almost certainly due to the facet joints. Thus it’s safe to assume that these joints are to blame. In certain circumstances, time-release cortisone injections may be used to reduce inflammation in these joints, which may provide long-term pain relief.

A long-acting local anesthetic or corticosteroid drug is used to numb the facet joint temporarily. After acquiring an appropriate block, the patient is asked to participate in activities that exacerbate their pain and document their therapy experiences 4-8 hours later. 

Facet joints are to blame when the symptoms of back discomfort go away for a lengthy period. Diagnostic blocks are used to establish the relative contribution of sympathetic nerves to the pain condition and locate the nerve(s) responsible for pain or neuromuscular dysfunction.

 CT guidance, a long-lasting anesthetic medicine, is injected into the joint or surrounding area into the nerve supplying the common to anesthetize it temporarily. The diagnostic blocks, facet joint denervation, may need a second injection to confirm the results are consistent. 

After the injection, the patient is urged to participate in activities that exacerbate their discomfort and write down impressions of the procedure during the first four to eight hours after the injection. Therapy may be advised if there is a significant reduction in back pain that lasts for a lengthy period.

Many nerve blocks may be necessary to diagnose and treat persistent pain in a single patient. Selecting the approach most likely to confirm or treat the presumptive diagnosis is a logical move. If the first method fails to provide the desired outcome or rule out the diagnosis, the practitioner may proceed to the next logical test or treatment.

Therefore, it is neither appropriate nor necessary to do a combination of the epidural, Facet joint, and bilateral sacroiliac joint injections, lumbar sympathetic block, or more than three levels of facet joint blocks on the same patient same day. In addition, a misdiagnosis or unnecessary treatment might occur from this kind of therapy.

64493 cpt code
64493 CPT code description

CPT Code 64493 Billing Guidelines

Coding and billing are more complicated than they seem to be. Facet standard injection coding requirements must be followed by billers, coders, and doctors to guarantee that your practice complies. In addition, the codes for facet joint injections have changed several times due to regulatory modifications. 

If therapy was previously classified in a particular manner, no one in the doctor’s office should assume that the status quo still applies. Every rheumatologist and their team should thoroughly understand facet joint injections.

Billing guidelines are given below:

Bilateral injections of CPT codes may be billed with Modifier 50 for each CPT code indicated (single level, second level, third level, and any future levels). For one-level unilateral or bilateral procedures, use CPT codes 64490 or 64493. When administering a facet joint injection to several joints, CPT codes 64491, 64492, CPT 64494, or 64495 should be used for each additional level. Procedure codes that use a single service number should have the Modifier 50 appended when performing bilateral surgeries.

It includes fluoroscopic and CT guidance and localization of needle placement.

The procedure should be invoiced if a paravertebral nerve injection is performed near or into a spinal nerve.

Facet joint nerve damage should only be billed for after the blockage since it is included in the budget for the procedure.

No non-facet pathology may explain the patient’s pain, including a fracture, tumor, infection, or substantial deformity.

According to a medical assessment, the facet joint may be the source of pain.

According to applicable CMS Local Coverage Determinations, Facet joint injections for diagnostic and therapeutic purposes are covered (LCDs). According to Medicare, a patient should not be given an epidural block or sympathetic block on the same day as facet injections.

 A wrong or partial diagnosis may be the consequence of many blocks being run on the same day. Unless the patient has recently stopped using an anticoagulant medication for pain management, coverage will only be extended for one kind of procedure during one day/session of therapy.

CPT Code 64493 Modifiers

The American Medical Association has recently updated the guidelines for bilateral surgeries, making it even more difficult to charge for pain therapy. In addition, some pain treatment strategies would be affected by the updated policies.

Any extra code that is added to primary, second, and third-level facet joint injections are a good example of this. Therefore, the American Medical Association recommends against using the 50 modifiers for add-on codes in their most recent CPT update.

As a 50 (bilateral) modifier, the first line item would be invoiced, followed by a right (RT) and left (LT) line item at each successive level (LT). It’s simple enough, but the new guidelines face an apparent challenge: payers may not embrace them.

For what does a provider charge for extra bilateral services? Although seasoned billing organizations will have mechanisms to assist them in navigating the new murky modifier waters, there is no simple answer.

In many cases, a change in regulations may lead to new learning experiences. One way to ensure that cash flow is not disturbed is to learn about the policies of large payers. Smaller payer rejections are another.

Providers must remember to meticulously document the procedure, paying particular attention to the laterality and location of each procedure stage. 

Coders committed and experienced may next use modifiers to maximize your income. If a billing company goes above and above for its consumers, they may easily handle the new criteria with little or no effort for the provider.

The CPT code 64493 modifier is 64493-50.

CPT Code 64493 Reimbursement

Regardless of the number of needles used or the number of medications delivered, only one facet injection code should be reported for each level and side injected. For example, a single needle puncture injection into the intra-articular Facet of the left L4-L5 is classified as 64493. 

When treating individuals with persistent back pain, radiological imaging is often utilized to rule out other potential causes of the pain. Performing a facet joint block is one method of documenting and correlating concerns about posterior essential biomechanical back pain.

Although you injected the L4-L5 facet joint’s medial branch nerves from both the L3 and L4 levels, you’d still label the procedure CPT code 64493.

A facet joint injection is employed to determine whether the patient’s back pain is caused by facet joint arthropathy. Testing whether an anesthetic would stop or ‘block’ pain is done at the facet joints, where the relevant spinal nerves flow.

During anesthesia, a steroid may be injected to help reduce inflammation.

A treatment procedure is known as radiofrequency (RF) ablation may be used if the patient’s satisfactory injection results. RF ablation For six months to a year, radiofrequency ablation (RF) destroys damaged spinal nerves, avoiding discomfort.

Because so many individuals have back pain, this procedure is valuable and vulnerable to misuse. For this reason, Medicare has done extensive research and has devised a set of preconditions before diagnostic testing and RF ablation may be carried out. You may get this information on the Medicare webpage.

To be reimbursed by Medicare for the services you offer, you must ensure that your providers know the requirements documented in the patient’s record. Let’s look at some of the most common issues while coding this method.

CPT Code 64493 Examples

The following are examples of when CPT code 64493 may be used.

Example 1

L4-L5 or L4-5

Coding: Each facet joint = CPT code is 64493 is one level code

Hyphens usually block the facet joint in the standard documentation.

Example 2

A facet block was done on the proper L4-5 Facet this week.

Codes: 64493-RT

Two nerves (L3 and L4) are injected on the right side of the facet joint (separated by a hyphen).

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