Coding Conundrum: Coding for Facet Cyst Aspiration

Question:

We are confused by AMA recommendations for the aspiration of a facet cyst. While researching, we found two CPT Assistants (2011 and 2017) advising to use an unlisted code, 64999. The Clinical Examples in Radiology CPT Assistant, February 2024 instructs to use CPT code 22899, not 64999. The rationale cited for recommending CPT code 22899 is because the procedure does not involve entering the facet joint and facet cysts are not considered to originate in the nervous system.

Which unlisted code does KZA recommend?

Answer:

Thank you for your detailed inquiry. We understand your confusion. KZA noted this discrepancy earlier this year while researching whether the AMA had published the updated guidance since the 2017 article.

KZA appreciates that both sources recommend an unlisted code. CPT code 64999 represents an unlisted procedure within the nervous system, while CPT code 22899 applies to unlisted spinal procedures

According to the latest guidance outlined in Clinical Examples in Radiology, Fall 2024, KZA recommends CPT code 22899 (unlisted procedure, spine) as the most appropriate code for aspiration of a facet cyst.

*This response is based on the best information available as of 9/25/25.