CPT® Code 64605

The procedure described by CPT® Code 64605 involves the destruction of the second and third division branches of the trigeminal nerve at the foramen ovale using a neurolytic agent. This intervention is primarily aimed at alleviating chronic pain, particularly in patients who have not responded to other pain management strategies. The destruction of nerve tissue can be achieved through various techniques, including the injection of a chemical neurolytic agent or the application of thermal, electrical, or radiofrequency methods. Among these, radiofrequency destruction is the most commonly utilized technique in contemporary practice. The procedure begins with the introduction of an electrode needle through the skin, which is then carefully advanced toward the targeted neural tissue. This step is crucial as it allows for motor and sensory testing to confirm the accurate positioning of the needle at the nerve responsible for the patient's pain. Once the correct nerve pathway is identified, the destruction of the nerve is performed. If a chemical neurolytic agent is employed, it is injected along the nerve pathway to achieve the desired effect. Common neurolytic agents include phenol, ethyl alcohol, glycerol, ammonium salt compounds, and hypertonic or hypotonic solutions. Alternatively, thermal or electrical modalities involve the use of a probe or needle that is inserted through the skin and activated to generate heat, effectively destroying the nerve tissue. In the case of radiofrequency nerve destruction, the electrode needle is positioned similarly, and once correctly placed, an electric current is activated to produce heat at the electrode's tip, leading to the destruction of the targeted nerve tissue. It is important to note that for procedures involving the destruction of other branches of the trigeminal nerve, such as the supraorbital, infraorbital, mental, or inferior alveolar branches, CPT® Code 64600 should be used. Additionally, when the destruction of the second or third division branches at the foramen ovale is performed without radiologic monitoring, CPT® Code 64605 is appropriate; however, if radiologic monitoring is utilized during the procedure, CPT® Code 64610 should be applied.