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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 each vertebra 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 0218T involves the injection of a diagnostic or therapeutic agent into the paravertebral facet joint or the nerves that innervate that joint, utilizing ultrasound guidance to ensure precise placement. This process 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, at which point a small amount of contrast material is injected to confirm the correct positioning of the needle. Subsequently, a local anesthetic and/or steroid is injected to provide pain relief. The diagnostic facet joint injection aims to identify the specific source of pain, and if significant relief is achieved, a therapeutic injection may be performed later using a long-acting local anesthetic combined with a steroid. For coding purposes, CPT® Code 0218T is specifically designated for the third and any additional lumbar or sacral facet joint injections, following the primary procedure codes for the first and second levels.
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Facet Joint Pain Pain associated with conditions such as post-laminectomy syndrome, spondylosis, spondylolisthesis, and arthritis may necessitate this procedure.
Step 1: Preparation The procedure begins with the preparation of the skin over the targeted paravertebral facet joint. This involves cleaning the area to reduce the risk of infection and ensure a sterile environment for the injection.
Step 2: Local Anesthetic Administration After the skin is prepared, a local anesthetic is injected to minimize discomfort during the procedure. This step is crucial for patient comfort and cooperation throughout the injection process.
Step 3: Needle Insertion A spinal needle is then carefully directed into the facet joint space. The physician advances the needle until it encounters bone or cartilage, which indicates that the needle is in the correct anatomical location.
Step 4: Contrast Injection To confirm the accurate positioning of the needle, a small amount of contrast material is injected. This step is essential to ensure that the injection is delivered precisely into the facet joint or the nerves innervating that joint.
Step 5: Therapeutic Injection Following the confirmation of needle placement, a local anesthetic and/or steroid is injected into the joint space. The local anesthetic provides immediate pain relief, while the steroid offers longer-lasting relief by reducing inflammation.
Step 6: Diagnostic Assessment The diagnostic facet joint injection is performed to identify the specific area generating pain. If the patient experiences significant pain relief for an extended period following this injection, it indicates that the facet joint is likely the source of the pain. In such cases, a therapeutic injection may be scheduled for a later date, utilizing a long-acting local anesthetic in conjunction with a steroid for enhanced pain management.
After the procedure, patients are typically monitored for a short period to assess their response to the injection and to ensure there are no immediate complications. Patients may experience some soreness at the injection site, which is generally mild and temporary. It is important for patients to follow any post-procedure instructions provided by their healthcare provider, which may include activity restrictions and recommendations for pain management. The expected recovery time can vary, but many patients may resume normal activities shortly after the procedure, depending on their individual response and the extent of the injection. Follow-up appointments may be scheduled to evaluate the effectiveness of the injection and to determine if further treatment is necessary.
| Short Descr | NJX PARAVERT W/US LUMB/SAC | Medium Descr | NJX PARAVERTBRL FCT JT W/US LUMB/SAC 3RD&> LVL | Long Descr | 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) | 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 | 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) |
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Notes
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| 2011-01-01 | Added | First appearance in code book. |
| 2010-01-01 | Added | Code implemented. |
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