Nerve Root Blocks

Nerve Root Blocks (Transforaminal Epidural Injection)

Nerve root blocks involve the selective injection of anesthetic agent and steroids via a transforaminal
approach adjacent to a nerve root to relieve pain in that nerve root distribution. This also describes
the transforaminal approach to epidural steroid injection at a localized level. This approach
may be performed after failed caudal epidural steroid injection therapy.

Procedure Description:

A cervical or thoracic transforaminal injection is commonly performed in cases of radiculopathy or radiculitis. Under the guidance of a fluoroscope, the physician identifies the cervical or thoracic vertebrate and its nerve root. The skin and subcutaneous tissue are anesthetized. A contrast material is injected to identify the area of the joint in relation to the needle tip. Then the physician administers a combination of anesthetic and steroid medication into the neuroforaminal epidural space.

Nerve Root Blocks - Cervical or Thoracic,

 

CPT 64479 - Injections, anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, single level 

CPT 64480 - Injections, anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional level (List separately in addition to code for primary procedure) 

Nerve Root Blocks -  Lumbar or Sacral

CPT 64483 - Injections, anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level 

CPT 64484 - Injections, anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional level (List separately in addition to code for primary procedure) 

Notes:

These codes are per level, per side treated. If one side is treated in a region, use the code once. If both sides are treated, use 50 modifier.

Do not use code 77003, 77012, or 76942, as guidance is bundled for transforaminal epidural
injections

Use codes 0228T-0231T for transforaminal epidural injections using ultrasound guidance.

0228T -  Injections, anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level 

0229T - Injections, 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) 

0230T - Injections, anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level 

0231T - Injections, anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; each additional level (List separately in addition to code for primary procedure)

Use unlisted code 22899 for injection of an anesthetic/steroid combination into a synovial cyst
via a laminar osteotomy.