CPT® Code 0229T | Case2Code

Code deleted, see 64999

Official Description

Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; each additional level (List separately in addition to code for primary procedure)

Common Language Description

A transforaminal epidural injection is a medical procedure designed to alleviate pain associated with conditions such as foraminal stenosis and large or lateral disc herniations. This procedure involves the precise delivery of an anesthetic agent and/or steroid into the epidural space, which is the area surrounding the spinal cord and nerve roots. The injection is performed under ultrasound guidance to ensure accurate placement of the needle. During the procedure, the patient is typically positioned in a prone (face down) position on the treatment table to facilitate access to the cervical or thoracic spine. The use of fluoroscopic guidance allows the physician to visualize the needle's trajectory as it is advanced through the skin and into the nerve root foramen of the affected vertebra. Once the needle is correctly positioned within the epidural space, contrast material is injected to confirm proper placement before administering the anesthetic and/or steroid. This procedure is coded with CPT® Code 0229T for each additional cervical or thoracic level injected, following the primary procedure coded with 0228T.

1. Indications

The transforaminal epidural injection is indicated for patients experiencing specific conditions that lead to pain and discomfort in the cervical or thoracic regions of the spine. These indications include:

Foraminal Stenosis - A narrowing of the foraminal space where nerve roots exit the spinal column, which can cause nerve compression and pain.
Large or Lateral Disc Herniations - The displacement of disc material that can impinge on nearby nerve roots, leading to pain, numbness, or weakness in the arms or upper body.

2. Procedure

The transforaminal epidural injection procedure involves several critical steps to ensure effective treatment. These steps include:

Patient Positioning - The patient is positioned in a prone (face down) position on the treatment table to provide optimal access to the cervical or thoracic spine.
Needle Insertion - Using fluoroscopic guidance, the physician carefully advances a needle through the skin and into the nerve root foramen of the affected vertebra. This step is crucial for targeting the correct area for injection.
Contrast Injection - Once the needle is in place, contrast material is injected to confirm that the needle is correctly positioned within the epidural space. This step helps to visualize the placement and ensures that the medication will be delivered to the intended area.
Injection of Anesthetic and/or Steroid - After confirming proper needle placement, an anesthetic agent and/or steroid is injected into the epidural space. This medication aims to reduce inflammation and alleviate pain associated with the underlying conditions.

3. Post-Procedure

After the transforaminal epidural injection, patients may be monitored for a short period to assess their response to the procedure. It is common for patients to experience some immediate relief from pain, although the full effects of the steroid may take several days to manifest. Patients are typically advised to rest and avoid strenuous activities for a short period following the injection. Additionally, they may receive specific instructions regarding pain management and follow-up appointments to evaluate the effectiveness of the treatment.

Short Descr	NJX TFRML EPRL W/US CER/THOR
Medium Descr	NJX ANES/STERD TFRML EDRL W/US CER/THOR EA ADDL
Long Descr	Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; each additional level (List separately in addition to code for primary procedure)
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)	1 - Statutory 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
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P6D - Minor procedures - other (non-Medicare fee schedule)
MUE	Not applicable/unspecified.
CCS Clinical Classification	231 - Other therapeutic procedures