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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 spinal 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 0217T 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 contacts 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, while a therapeutic injection may be performed later if the patient experiences significant pain relief, utilizing a long-acting local anesthetic combined with a steroid. For coding purposes, CPT® Code 0216T is used for a single lumbar or sacral facet joint injection, CPT® Code 0217T is designated for the second level, and CPT® Code 0218T is applicable for the third and any additional lumbar or sacral levels injected.
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Facet joint injections are indicated for various conditions that may cause pain in the lumbar or sacral regions. The following are explicitly provided indications for this procedure:
The procedure for a paravertebral facet joint injection with ultrasound guidance involves several critical steps to ensure accuracy and patient safety. The following procedural steps are outlined:
After the facet joint injection, patients are typically monitored for a short period to assess their response to the procedure and to ensure there are no immediate complications. It is common for patients to experience some soreness at the injection site, which may resolve within a few days. Patients may be advised to avoid strenuous activities for a short time following the injection to allow for proper healing. If the initial diagnostic injection provides significant pain relief, a therapeutic injection may be scheduled for a later date, utilizing a long-acting local anesthetic in conjunction with a steroid to enhance pain management. Follow-up appointments may be necessary to evaluate the effectiveness of the injection and to determine any further treatment options if needed.
| Short Descr | NJX PARAVERT W/US LUMB/SAC | Medium Descr | NJX DX/THER PARAVER FCT JT W/US LUMB/SAC LVL 2 | Long Descr | 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) | Status Code | Carriers Price the Code | Global Days | ZZZ - Code Related to Another Service | 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 | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | 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 an add-on code that must be used in conjunction with one of these primary codes.
| 0216T | MPFS Status: Carrier Priced APC T ASC R2 CPT Assistant Article Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level | 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). | 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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