Answer
Procedure Codes: 64493, 64494, J2920 x 2
ICD-9 Diagnosis Code: 721.3
ICD-10: M47.816
CPT code 64493 is defined as an “Injection(s), diagnostic or therapeutic agent paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level.” CPT code 64494 is the “second level (list separately in addition to code for primary procedure).”
According to the 2014 AMA CPT, “Image guidance [fluoroscopy or CT] and any injection of contrast are inclusive components of 64490–64495. Imaging guidance and localization are required for the performance of paravertebral facet joint injections described by codes 64490–64495. If imaging is not used, CPT codes 20552–20553 will have to be billed. If ultrasound guidance is used, report 0213T–0218T.”
Keep in mind that this was a scheduled visit for the injections and there was no significant, separately identifiable evaluation and management service done; therefore, no E/M visit could be billed.
If you have any questions or comments on this matter, contact Melesia Tillman, CPC, CPC-I, CRHC, CHA, at mtillman@rhuematology.org or 404-633-3777 x820.