Allogeneic Injection of Lumbar Spine
CPT Assistant, October 2021, Volume 31, Issue 10, page 10
For the Current Procedural Terminology (CPT®) 2021 code set, four new Category III codes (0627T-0630T) were established to report percutaneous lumbar spine injection of allogeneic cellular and/or tissue-based product with either fluoroscopic or computed tomography (CT) guidance. Prior to 2021, code 22899, Unlisted procedure, spine, or 64999, Unlisted procedure, nervous system, were used to report these procedures. Exclusionary parenthetical notes were added throughout the CPT code set to indicate when it is inappropriate to report these new Category III codes in conjunction with other services. This article provides an overview of the new codes.
Category III Codes
(Use 0628T in conjunction with 0627T)
(Do not report 0627T, 0628T in conjunction with 77003)(Use 0630T in conjunction with 0629T) (Do not report 0629T, 0630T in conjunction with 77012) New codes 0627T-0630T describe image-guided percutaneous injections into the lumbar intervertebral discs for patients with discogenic chronic low-back pain. Codes 0629T (first level) and 0628T (each additional level) are reported when fluoroscopic guidance is used. Codes 0629T (first level) and 0630T (each additional level) are reported when CT guidance is used. With the establishment of these new Category III codes, the exclusionary parenthetical note following code 77003 was revised to include codes 0627T and 0628T, which prohibits reporting these codes together with code 77003. A similar exclusionary parenthetical note following code 77012 was revised to indicate that code 77012 may not be reported with codes 0629T and 0630T.
The following clinical examples and procedural descriptions reflect typical clinical scenarios for which these new codes would be appropriately reported.
Clinical Example (0627T)
A 38-year-old male with discogenic chronic lower back pain with radiographic evidence of lumbar degenerative disc disease (DDD), Pfirrmann grade III-VII, who remains symptomatic despite conservative therapy and wishes to avoid opioids and/or spinal surgery, undergoes therapeutic percutaneous injection of allogeneic disc tissue matrix into the lumbar intervertebral disc under fluoroscopic imaging guidance.
Description of Procedure (0627T)
Remove the cell vial and mixing system containing allograft tissue from the outer packaging using standard aseptic technique. Thaw and prepare cell solution for injection. Ensure the cell solution and allograft and saline components are mixed thoroughly. Draw 1.75 mL of the prepared allogeneic disc matrix into a 3-mL syringe.
Place the patient in prone position on the fluoroscopic table. Prepare the skin with an antiseptic solution and drape the patient in the usual sterile fashion. Perform preliminary fluoroscopy to localize the target vertebral body, which is marked.
Infiltrate the skin and deeper tissues with local anesthetic. Insert a spinal needle through Kambin's safe triangle at the appropriate disc level.
After the appropriate position of the needle tip is confirmed by fluoroscopic imaging, connect a syringe with the allograft to the needle and inject 1.25 mL to 1.75 mL of the allograft into the affected disc under real-time fluoroscopic imaging. Remove the needle and apply bandages to injection site.
Clinical Example (0628T)
A 38-year-old male with discogenic chronic lower back pain with radiographic evidence of lumbar DDD (Pfirrmann grade III-VII) at an additional level, who remains symptomatic despite conservative therapy and wishes to avoid opioids and/or spinal surgery, undergoes therapeutic percutaneous injection of allogeneic disc tissue matrix of the lumbar intervertebral disc under fluoroscopic imaging guidance.
Description of Procedure (0628T)
Treat an additional level, repeating the same steps as the primary procedure. Remove the cell vial and mixing system containing allograft tissue from the outer packaging using standard aseptic technique. Place the cell vial and mixing system in the operative field. Thaw and prepare the cell solution for injection. Ensure the cell solution and allograft/saline components are mixed thoroughly. Draw 1.75 mL of the prepared allogeneic disc matrix into a 3-mL syringe. Place the patient in the prone position on the fluoroscopic table. Prepare the skin with an antiseptic solution and drape the patient in the usual sterile fashion. Perform preliminary fluoroscopy to localize the target vertebral body, which is marked.
Infiltrate the skin and deeper tissues are infiltrated with local anesthetic. Insert a spinal needle through Kambin's safe triangle at the appropriate disc level.
After the appropriate position of the needle tip is confirmed by fluoroscopic imaging, connect a syringe with the allograft to the needle and inject 1.25 mL to 1.75 mL of the allograft into the affected disc under real-time fluoroscopic imaging. Remove the needle and apply bandages to the site of injection.
Clinical Example (0629T)
A 37-year-old female with discogenic chronic lower back pain with MRI evidence of lumbar degenerative disc disease (DDD) that is moderate (Pfirrmann grade IIIVII), who remains symptomatic despite conservative therapy and injections and wishes to avoid systemic opioids and/or spinal surgery, undergoes therapeutic percutaneous injection of allogeneic disc tissue matrix into the lumbar intervertebral disc under computed tomography (CT) imaging guidance.
Description of Procedure (0629T)
Remove the cell vial and mixing system containing allograft tissue from the outer packaging using standard aseptic technique. Place the cell vial and mixing system in the operative field. Thaw and prepare the cell solution for injection. Ensure the cell solution and allograft and saline components are mixed thoroughly. Draw 1.75 mL of the prepared allogeneic disc matrix into a 3-mL syringe. Place the patient in prone position on the CT table. Prepare the skin with an antiseptic solution and drape the patient in the usual sterile fashion. Perform a scanogram and initial CT slices through the affected lumbar disc(s) to localize the target, which is marked.
Infiltrate the skin and deeper tissues with local anesthetic. Insert a spinal needle through Kambin's safe triangle at the appropriate disc level.
After the appropriate position of the needle tip is confirmed by CT imaging, connect a syringe with the allograft to the needle and inject 1.25 mL to 1.75 mL of the allograft into the affected disc. Remove the needle and apply bandages to the site of injection.
Clinical Example (0630T)
A 37-year-old female with discogenic chronic lower back pain with MRI evidence of moderate lumbar DDD (Pfirrmann grade III-VII), who remains symptomatic despite conservative therapy and injections and wishes to avoid systemic opioids and/or spinal surgery, undergoes therapeutic percutaneous injection of allogeneic disc tissue matrix into the lumbar intervertebral disc under CT imaging guidance.
Description of Procedure (0630T)
Treat an additional level, repeating the same steps as the primary procedure.
Remove the cell vial and mixing system containing allograft tissue from the outer packaging using standard aseptic technique. Place the cell vial and mixing system in the operative field. Thaw and prepare the cell solution for injection. Ensure the cell solution and allograft and saline components are mixed thoroughly. Draw 1.75 mL of the prepared allogeneic disc matrix into a 3-mL syringe.
Place the patient in prone position on the CT table. Prepare the skin with an antiseptic solution and drape the patient in the usual sterile fashion. Perform a scanogram and initial CT slices through the affected lumbar disc(s) to localize the target, which is marked. Infiltrate the skin and deeper tissues with local anesthetic. Insert a spinal needle through Kambin's (safe) triangle at the appropriate disc level. Take care to avoid injury to surrounding structures.
After the appropriate position of the needle tip is confirmed by CT imaging, connect a syringe with the allograft to the needle and inject 1.25 mL to 1.75 mL of the allograft into the affected disc. Remove the needle and apply bandages to the site of injection.
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