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Paravertebral facet joints, also known as zygapophyseal joints, are critical structures located at the posterior aspect of the spine, situated on either side of the vertebrae where one vertebra overlaps another. These joints play a significant role in spinal movement and stability. Pain originating from these joints can be attributed to various conditions, including post-laminectomy syndrome, which may arise after spinal surgery that destabilizes the joints, leading to scar tissue formation or recurrent disc herniation. Other potential causes of facet joint pain include degenerative conditions such as spondylosis, spondylolisthesis, and arthritis. The procedure described by CPT® Code 0213T involves the injection of a diagnostic or therapeutic agent into the paravertebral facet joint or the nerves that innervate that joint, utilizing ultrasound guidance for precision. This technique begins with the preparation of the skin over the facet joint, followed by the administration of a local anesthetic to minimize discomfort. A spinal needle is then carefully directed into the facet joint space until it encounters bone or cartilage, ensuring accurate placement. To confirm the correct positioning of the needle, a small amount of contrast material is injected. Subsequently, a local anesthetic and/or steroid is administered. The diagnostic facet joint injection aims to identify the specific source of pain by using a local anesthetic. If the patient experiences significant pain relief after this diagnostic injection, a therapeutic injection may be performed on a subsequent date, utilizing a long-acting local anesthetic combined with a steroid for prolonged relief. For coding purposes, 0213T is used for a single cervical or thoracic facet joint injection, while 0214T is designated for the second level, and 0215T is used for the third and any additional cervical or thoracic levels injected.
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The procedure described by CPT® Code 0213T is indicated for various conditions that may cause pain in the paravertebral facet joints. These indications include:
The procedure for a paravertebral facet joint injection with ultrasound guidance involves several critical steps to ensure accuracy and patient safety. The first step is the preparation of the skin over the targeted facet joint, which includes cleaning the area to reduce the risk of infection. Following this, a local anesthetic is injected to numb the skin and surrounding tissues, minimizing discomfort during the procedure. The next step involves the careful insertion of a spinal needle into the facet joint space. The physician directs the needle until it encounters bone or cartilage, which indicates that the needle is in the correct position. To confirm the placement of the needle, a small amount of contrast material is injected. This step is crucial as it verifies that the needle is accurately positioned within the joint space. Once the correct placement is confirmed, the physician proceeds with the injection of a local anesthetic and/or a steroid into the facet joint. The local anesthetic serves a dual purpose: it provides immediate pain relief and helps to identify the specific area generating the pain during the diagnostic phase. If the patient reports significant pain relief following this injection, a therapeutic injection may be scheduled for a later date, which would utilize a long-acting local anesthetic in combination with a steroid for extended relief.
After the completion of the facet joint injection, patients are typically monitored for a short period to assess for any immediate adverse reactions. It is common for patients to experience some soreness at the injection site, which may resolve within a few days. Patients are usually advised to avoid strenuous activities or heavy lifting for a short period following the procedure to allow for proper healing. Additionally, they may be instructed to apply ice to the injection site to reduce swelling and discomfort. Follow-up appointments may be scheduled to evaluate the effectiveness of the injection and to determine if further therapeutic injections are necessary based on the patient's response to the initial treatment.
| Short Descr | NJX PARAVERT W/US CER/THOR | Medium Descr | NJX DX/THER PARAVER FCT JT W/US CER/THOR 1 LVL | Long Descr | Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level | Status Code | Carriers Price the Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Office-based surgical procedure added to ASC list in CY 2008 or later without MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight. | Type of Service (TOS) | 9 - Other Medical Items or Services | Berenson-Eggers TOS (BETOS) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 231 - Other therapeutic procedures |
This is a primary code that can be used with these additional add-on codes.
| 0214T | Addon Code MPFS Status: Carrier Priced APC N ASC N1 CPT Assistant Article Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; second level (List separately in addition to code for primary procedure) | 0215T | Addon Code MPFS Status: Carrier Priced APC N ASC N1 CPT Assistant Article Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; third and any additional level(s) (List separately in addition to code for primary procedure) |
| 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GA | Waiver of liability statement issued as required by payer policy, individual case | GZ | Item or service expected to be denied as not reasonable and necessary | KX | Requirements specified in the medical policy have been met | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2011-01-01 | Added | First appearance in code book. |
| 2010-01-01 | Added | Code implemented. |
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