How To Use CPT Code 64494

CPT 64494 refers to an add-on procedure involving the injection of a diagnostic or therapeutic agent into a paravertebral facet joint or nerves innervating that joint at the lumbar or sacral level, using image guidance. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 64494 procedures.

1. What is CPT 64494?

CPT 64494 is an add-on code used to describe a procedure in which a diagnostic or therapeutic agent is injected into a paravertebral facet joint or nerves innervating that joint at the lumbar or sacral level, using image guidance such as fluoroscopy or CT. This procedure is typically performed to treat spinal pain or identify the exact source of pain after an initial separately reportable injection.

2. 64494 CPT code description

The official description of CPT code 64494 is: “Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure)”.

3. Procedure

1. The provider preps and anesthetizes the patient for a second lumbar or sacral level 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 provider injects the therapeutic or diagnostic agent, such as a steroid or anesthetic mixture.
4. The needle is removed, and the provider ensures that the site obtains hemostasis.

4. Qualifying circumstances

Patients eligible to receive CPT 64494 services are those experiencing spinal pain or requiring identification of the exact source of pain after an initial separately reportable injection. The procedure is typically performed on patients who have not responded to conservative treatments such as physical therapy, medications, or rest. It is essential to ensure that the patient has undergone a thorough evaluation, including a physical examination and imaging studies, to determine the appropriateness of the procedure.

5. When to use CPT code 64494

It is appropriate to bill the 64494 CPT code when the provider performs a second level lumbar or sacral facet joint injection or injection for nerves innervating that joint, using image guidance, after an initial separately reportable injection. The procedure aims to treat spinal pain or identify the exact source of pain. CPT 64494 should be used in conjunction with the appropriate primary code, such as 64493 for the initial lumbar or sacral level.

6. Documentation requirements

To support a claim for CPT 64494, the following information should be documented:

• Patient’s medical history and physical examination findings
• Indication for the procedure, including the failure of conservative treatments
• Details of the initial separately reportable injection
• Specifics of the second level injection, including the location, type of agent used, and image guidance method
• Post-procedure findings, such as pain relief or diagnostic information obtained
• Any complications or adverse events encountered during the procedure

7. Billing guidelines

When billing for CPT code 64494, it is essential to remember that it is an add-on code and should be used in conjunction with the appropriate primary code, such as 64493 for the initial lumbar or sacral level. Payers will not reimburse for 64494 if reported without an appropriate primary code. Additionally, imaging guidance, specifically fluoroscopy or CT, should not be separately reported. CPT 64494 may not be reported more than once per day.

8. Historical information

CPT 64494 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 64494

Five similar codes to CPT 64494 and how they differentiate are:

• CPT 64490: Describes the injection of a diagnostic or therapeutic agent into a paravertebral facet joint or nerves innervating that joint at the cervical or thoracic level, using image guidance.
• CPT 64491: An add-on code for the second level cervical or thoracic facet joint injection or injection for nerves innervating that joint, using image guidance.
• CPT 64492: An add-on code for the third and any additional levels of cervical or thoracic facet joint injections or injections for nerves innervating those joints, using image guidance.
• CPT 64493: Describes the injection of a diagnostic or therapeutic agent into a paravertebral facet joint or nerves innervating that joint at the lumbar or sacral level, using image guidance, for the initial level.
• CPT 64495: An add-on code for the third and any additional levels of lumbar or sacral facet joint injections or injections for nerves innervating those joints, using image guidance.

10. Examples

1. A patient with chronic low back pain undergoes an initial lumbar facet joint injection at the L3-L4 level (CPT 64493) and a second level injection at the L4-L5 level (CPT 64494) using fluoroscopic guidance.
2. A patient with sacroiliac joint pain receives an initial sacral facet joint injection at the S1-S2 level (CPT 64493) and a second level injection at the S2-S3 level (CPT 64494) using CT guidance.
3. A patient with lumbar radiculopathy undergoes an initial lumbar nerve root injection at the L5 level (CPT 64493) and a second level injection at the S1 level (CPT 64494) using fluoroscopic guidance.
4. A patient with lumbar spinal stenosis receives an initial lumbar facet joint injection at the L2-L3 level (CPT 64493) and a second level injection at the L3-L4 level (CPT 64494) using CT guidance.
5. A patient with failed back surgery syndrome undergoes an initial lumbar facet joint injection at the L4-L5 level (CPT 64493) and a second level injection at the L5-S1 level (CPT 64494) using fluoroscopic guidance.
6. A patient with lumbar spondylolisthesis receives an initial lumbar facet joint injection at the L5-S1 level (CPT 64493) and a second level injection at the L4-L5 level (CPT 64494) using CT guidance.
7. A patient with lumbar degenerative disc disease undergoes an initial lumbar facet joint injection at the L3-L4 level (CPT 64493) and a second level injection at the L4-L5 level (CPT 64494) using fluoroscopic guidance.
8. A patient with lumbar facet joint arthritis receives an initial lumbar facet joint injection at the L2-L3 level (CPT 64493) and a second level injection at the L3-L4 level (CPT 64494) using CT guidance.
9. A patient with lumbar foraminal stenosis undergoes an initial lumbar nerve root injection at the L4 level (CPT 64493) and a second level injection at the L5 level (CPT 64494) using fluoroscopic guidance.
10. A patient with lumbar facet joint cysts receives an initial lumbar facet joint injection at the L4-L5 level (CPT 64493) and a second level injection at the L5-S1 level (CPT 64494) using CT guidance.