CPT® Code 64623

Code deleted, to report see 64633-64636

Official Description

Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, each additional level (List separately in addition to code for primary procedure)

Common Language Description

Paravertebral facet joints, also known as zygapophyseal joints, are critical structures located on the posterior aspect of the spine, situated on each side of the vertebrae where one vertebra overlaps another. The procedure described by CPT® Code 64623 involves the destruction of the paravertebral facet joint nerve using a neurolytic agent, specifically targeting the lumbar or sacral regions of the spine. This procedure is typically performed when conservative treatments have failed to alleviate pain associated with conditions affecting these joints. The use of a neurolytic agent, which can include substances such as phenol, ethyl alcohol, glycerol, ammonium salt compounds, and hypertonic or hypotonic solutions, aims to disrupt the nerve pathways responsible for transmitting pain signals. The procedure is conducted under fluoroscopic guidance to ensure accurate placement of the needle and agent, enhancing the effectiveness of the treatment while minimizing potential complications. This code is specifically used for each additional level treated, following the primary procedure, which is reported separately. Understanding the anatomy and function of the facet joints, as well as the techniques employed in this procedure, is essential for medical coders and billers to ensure accurate coding and reimbursement.

1. Indications

Chronic Pain The procedure is indicated for patients experiencing chronic pain originating from the lumbar or sacral facet joints, particularly when conservative treatments have been ineffective.
Facet Joint Dysfunction Patients with diagnosed facet joint dysfunction may benefit from this procedure to alleviate pain and improve function.
Failed Conservative Management This procedure is typically considered when other non-invasive treatments, such as physical therapy or medication, have not provided sufficient relief.

2. Procedure

Preparation The skin over the targeted facet joint is thoroughly prepped to maintain a sterile environment. A local anesthetic is injected to minimize discomfort during the procedure.
Needle Insertion A spinal needle is carefully directed into the facet joint space. The clinician advances the needle until bone or cartilage is encountered, ensuring accurate placement.
Contrast Injection A small amount of contrast material is injected through the needle to confirm correct positioning within the facet joint space. This step is crucial for verifying that the needle is in the appropriate location before proceeding.
Verification of Placement Following the contrast injection, a local anesthetic and/or steroid may be administered to further confirm the correct placement of the needle along the nerve pathway.
Neurolytic Agent Injection Once the needle is confirmed to be in the correct position, the selected neurolytic agent is injected along the nerve pathway to destroy the nerve tissue responsible for pain transmission.
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 for motor and sensory testing to ensure proper positioning.
Nerve Destruction Once the correct nerve pathway is identified, the probe, needle, or 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-procedural care. Monitoring for any adverse reactions or complications is essential. Patients are usually advised to rest and may be given specific instructions regarding activity levels and pain management. Follow-up appointments may be scheduled to assess the effectiveness of the procedure and determine if additional treatments are necessary. It is important for healthcare providers to document the procedure thoroughly, including the specific levels treated and the neurolytic agent used, to ensure accurate coding and billing.

Short Descr	DESTR PARAVERTEBRAL N ADD-ON
Medium Descr	DSTRJ NULYT PVRT FACET JT NRV LMBR/SAC EA LVL
Long Descr	Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, each additional level (List separately in addition to code for primary procedure)
Status Code	Active Code
Global Days	ZZZ - Code Related to Another Service
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No 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