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Paravertebral facet joints, also known as zygapophyseal joints, are critical structures located on 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 occur 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 0216T 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 to provide pain relief. The initial injection serves a diagnostic purpose, helping to identify the specific source of pain. If the patient experiences significant pain relief following 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 billing purposes, CPT® Code 0216T is designated for a single lumbar or sacral facet joint injection, while additional levels can be billed using CPT® Codes 0217T and 0218T for subsequent injections at the second and third levels, respectively.
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The procedure described by CPT® Code 0216T is indicated for the following conditions:
The procedure for a paravertebral facet joint injection with ultrasound guidance involves several critical steps to ensure accuracy and patient safety.
Post-procedure care following a paravertebral facet joint injection includes monitoring the patient for any immediate side effects or complications, such as infection or allergic reactions. Patients are typically advised to rest for a short period after the injection and may be instructed to avoid strenuous activities for a specified duration. The physician may schedule a follow-up appointment to assess the effectiveness of the injection and determine if further treatment is necessary. If the initial diagnostic injection provides significant pain relief, a therapeutic injection may be planned for a later date, utilizing a long-acting local anesthetic in conjunction with a steroid for enhanced pain management.
| Short Descr | NJX PARAVERT W/US LUMB/SAC | Medium Descr | NJX DX/THER PARAVER FCT JT W/US LUMB/SAC 1 LVL | Long Descr | Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; 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.
| 0217T | 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, lumbar or sacral; second level (List separately in addition to code for primary procedure) | 0218T | 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, lumbar or sacral; 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. | 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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