CPT® Code 64622

Code deleted, to report see 64633-64636

Official Description

Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level

Common Language Description

The procedure described by CPT® Code 64622 involves the destruction of the paravertebral facet joint nerve located in the lumbar or sacral region of the spine. Paravertebral facet joints, also known as zygapophyseal joints, are situated on the posterior aspect of the spine, where adjacent vertebrae overlap. This procedure is typically performed to alleviate pain associated with conditions affecting these joints. The technique utilizes a neurolytic agent, which is a chemical substance that destroys nerve tissue, thereby interrupting pain transmission. The procedure is conducted under fluoroscopic guidance, which allows for precise visualization of the anatomy and accurate placement of the needle. Prior to the injection of the neurolytic agent, the skin over the facet joint is prepared, and a local anesthetic is administered to minimize discomfort. The use of a spinal needle enables the physician to access the facet joint space, where contrast material may be injected to confirm proper needle placement. Following this, the neurolytic agent is injected along the nerve pathway to achieve the desired therapeutic effect. Various neurolytic agents can be employed, including phenol, ethyl alcohol, glycerol, ammonium salt compounds, and hypertonic or hypotonic solutions. Additionally, thermal or electrical modalities may be utilized, where a probe or electrode is inserted to generate heat that destroys the nerve tissue. This comprehensive approach aims to provide significant pain relief for patients suffering from facet joint-related conditions.

1. Indications

The procedure described by CPT® Code 64622 is indicated for the treatment of pain associated with conditions affecting the lumbar or sacral paravertebral facet joints. The following conditions may warrant this procedure:

Facet Joint Syndrome Pain originating from the facet joints due to degeneration or injury.
Chronic Low Back Pain Persistent pain in the lower back that has not responded to conservative treatments.
Radiculopathy Nerve root pain that may be associated with facet joint irritation.

2. Procedure

The procedure for CPT® Code 64622 involves several key steps to ensure effective destruction of the paravertebral facet joint nerve:

Preparation The skin over the targeted facet joint is thoroughly cleaned and prepped to reduce the risk of infection. A local anesthetic is then injected to numb the area, ensuring patient comfort during the procedure.
Needle Insertion A spinal needle is carefully directed into the facet joint space. The physician advances the needle until it encounters bone or cartilage, indicating the correct location. To confirm proper placement, a small amount of contrast material is injected, allowing for fluoroscopic visualization.
Verification of Placement Following the contrast injection, additional local anesthetic and/or steroid may be administered to further verify the accuracy of the needle's position along the nerve pathway.
Injection of Neurolytic Agent Once the correct position is confirmed, the selected neurolytic agent is injected along the nerve pathway. This agent may include substances such as phenol, ethyl alcohol, glycerol, or other chemical compounds designed to destroy nerve tissue.
Thermal or Electrical Modality (if applicable) In cases where thermal or electrical modalities are used, an electrode needle is introduced through the skin and advanced toward the targeted neural tissue. The needle is connected to a generator, and motor and sensory testing are performed to ensure correct positioning. Once the nerve pathway is confirmed, the electrode is activated to generate heat, effectively destroying the targeted nerve tissue.

3. Post-Procedure

After the procedure, patients may experience some discomfort at the injection site, which is typically managed with standard post-procedure care. Monitoring for any adverse reactions is essential, and patients are often advised to rest and avoid strenuous activities for a short period. Follow-up appointments may be scheduled to assess the effectiveness of the procedure and to determine if additional treatments are necessary. It is important for patients to report any unusual symptoms or prolonged pain to their healthcare provider.

Short Descr	DESTR PARAVERTEBRL NERVE L/S
Medium Descr	DSTRJ NULYT PVRT FACET JT NRV LMBR/SAC 1 LVL
Long Descr	Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level
Status Code	Active Code
Global Days	010 - Minor Procedure
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Discontinued Code
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P5E - Ambulatory procedures - other
MUE	Not applicable/unspecified.
CCS Clinical Classification	9 - Other OR therapeutic nervous system procedures