Procedure: 64493, 64493 -50 Diagnosis: 721.3
64493: Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with the image guidance (fluoroscopy or CT), lumbar or sacral; single level.
64493 -50: This is used to bill the injection for the second facet joints between L4–L5.
This was a scheduled visit for the injections and there was no significant, separately identifiable evaluation and management service done, so no office visit can be billed.
As of January 1, 2010, image guidance—fluoroscopy or CT—is inclusive with the procedure code. It is no longer permissible to bill the image guidance as a separate charge for this procedure. Also, if either the fluoroscopy or CT guidance is not done with this procedure, the code must be reported as 20550–20553. If ultrasound guidance—76942—is used, then the code must be reported as 64999. This is according to 2010 CPT coding guidelines.
If you have any questions or need additional information, contact Melesia Tillman, CPC, CRHC, CHA, at (404) 633–3777, ext. 820, or at mtillman@rhuematology.org.