CPT® Code 64627

Code deleted, to report see 64633-64636

Official Description

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

Common Language Description

The CPT® Code 64627 refers to the procedure of destruction by a neurolytic agent of the paravertebral facet joint nerve specifically in the cervical or thoracic regions of the spine. Paravertebral facet joints, also known as zygapophyseal joints, are located at the back of the spine, where adjacent vertebrae meet. This procedure is typically performed to alleviate pain associated with conditions affecting these joints. The process involves the use of a neurolytic agent, which is a chemical substance that destroys nerve tissue, thereby interrupting pain signals sent to the brain. The procedure is conducted under fluoroscopic guidance, ensuring precise targeting of the nerve. 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 procedure may involve the use of a spinal needle to access the facet joint space, where contrast material is 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 utilized, including phenol, ethyl alcohol, glycerol, ammonium salt compounds, and hypertonic or hypotonic solutions. Additionally, thermal or electrical modalities may be employed, where a probe or electrode is used to generate heat that destroys the nerve tissue. This procedure is typically reported separately for each additional cervical or thoracic level treated, following the primary procedure code.

1. Indications

The procedure described by CPT® Code 64627 is indicated for patients experiencing pain related to conditions affecting the paravertebral facet joints in the cervical or thoracic regions. The following conditions may warrant this procedure:

Chronic Pain Persistent pain in the cervical or thoracic spine that has not responded to conservative treatments.
Facet Joint Syndrome Pain originating from the facet joints due to inflammation or degeneration.
Radiculopathy Nerve root pain that may be associated with facet joint issues.

2. Procedure

The procedure for CPT® Code 64627 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, ammonium salt compounds, or hypertonic/hypotonic solutions, all of which are designed to destroy nerve tissue.
Thermal or Electrical Modality (if applicable) In some cases, a thermal or electrical modality may be used. An electrode needle is introduced through the skin and advanced toward the targeted neural tissue. The needle is connected to a generator, which allows for motor and sensory testing to ensure correct positioning. Once the nerve pathway is identified, 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. It is important for patients to follow any specific instructions provided by their healthcare provider regarding activity restrictions and pain management. Recovery time may vary, but many patients can resume normal activities within a few days. Follow-up appointments may be scheduled to assess the effectiveness of the procedure and to monitor for any potential complications.

Short Descr	DESTR PARAVERTEBRAL N ADD-ON
Medium Descr	DSTRJ NULYT PVRT FACET JT NRV CRV/THRC EA LVL
Long Descr	Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, 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)	none
MUE	Not applicable/unspecified.
CCS Clinical Classification	9 - Other OR therapeutic nervous system procedures