Current Procedural Terminology (CPT) is the standardized coding system used to document and bill for healthcare services. CPT 64493 identifies a specific therapeutic and diagnostic injection procedure targeting the lower back. This intervention aims to relieve pain originating in the lumbar or sacral region of the spine. It is a precisely guided procedure used for patients suffering from chronic pain who have not responded to more conservative treatments.
The Medical Procedure Behind CPT 64493
The procedure represented by CPT 64493 is a type of nerve block targeting the medial branch nerves that supply the facet joints of the lower spine. Facet joints are small, paired connections located on the back of the vertebrae that enable movement and prevent excessive rotation. When these joints become inflamed due to arthritis, injury, or degenerative changes, they can generate chronic lower back pain. The injection involves delivering a combination of a local anesthetic and a corticosteroid medication to the specific nerves innervating the joint. To ensure precision, the procedure requires image guidance, typically using fluoroscopy, which is a real-time X-ray technique. This guidance allows the specialist to meticulously place a thin needle near the targeted medial branch nerves or directly into the facet joint capsule.
The Purpose of Facet Joint Injections
Facet joint injections serve a dual purpose: they are both diagnostic and therapeutic tools in managing chronic back pain. Diagnostically, the procedure confirms if the facet joint is the source of the patient’s pain. This confirmation occurs if the injection of a local anesthetic provides at least 50% temporary pain relief within an hour. If relief is significant, it validates the facet joint as the primary pain generator, often leading to a diagnosis of facet joint syndrome.
Therapeutically, the corticosteroid medication reduces inflammation within the joint or around the medial branch nerves, providing longer-lasting pain relief. While the anesthetic provides immediate but temporary numbness, the steroid’s anti-inflammatory effects generally take a few days to take hold, offering relief that can last for weeks or months. This interventional approach is used after initial conservative measures, such as physical therapy, anti-inflammatory drugs, and rest, have failed. The procedure helps specialists determine the next steps in a patient’s pain management plan, which may include a more permanent nerve treatment like radiofrequency ablation.
Understanding the Code: What “Second Level” Means for Treatment
CPT codes for facet joint interventions are structured hierarchically based on the number of spinal levels injected. CPT 64493 specifically designates the injection of the single or primary level in the lumbar or sacral region, such as the L4-L5 joint. This code covers the first facet joint level treated in a single session.
The concept of a “second level” is represented by the add-on code, CPT 64494, which is billed in addition to the primary code, 64493, when a second adjacent level is treated. For example, if a patient receives injections at both the L4-L5 and L5-S1 levels, 64493 covers the first level, and 64494 covers the second. This numerical structure accurately reflects the increasing complexity and resources required for multi-level treatments. CPT 64495 is used for the third and any additional levels treated beyond the first two, standardizing the documentation of a multi-level procedure.
What to Expect: The Procedure and Aftercare
Patient preparation for a facet joint injection involves a few logistical steps to ensure safety and accuracy. Physicians often advise patients to fast for a few hours before the procedure, especially if light sedation will be used. Patients are also instructed to temporarily stop taking blood-thinning medications for several days leading up to the injection to minimize the risk of bleeding.
During the procedure, the patient lies on a table while the physician uses fluoroscopy to guide the needle toward the targeted facet joint or medial branch nerve. After a local anesthetic numbs the skin, a contrast dye may be injected to confirm correct needle placement before the medication mixture is delivered. The entire injection process is brief, typically lasting only a few minutes, though the overall visit includes preparation and a short recovery period.
Following the injection, patients are monitored briefly before being discharged and must arrange for a ride home due to the use of anesthetic agents. Temporary soreness at the injection site is common for a day or two and can be managed with ice. Patients are advised to take it easy for the first 24 to 48 hours, avoiding strenuous activities or heavy lifting to allow the medication to settle and begin its work.