CPT® Code 64629

Add-On Code

Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; each additional vertebral body, lumbar or sacral (List separately in addition to code for primary procedure)

Thermal destruction of the intraosseous basivertebral nerve is a specialized procedure aimed at alleviating chronic low back pain. This technique specifically targets the basivertebral nerves, which are sensory nerves located within the center of the vertebral body and at the vertebral end plates. These nerves exit the vertebral body through the basivertebral foramen, and their activation is often associated with "vertebrogenic" pain, a type of pain believed to arise from degeneration of the intervertebral disc and the vertebral endplates. The procedure is performed using a transpedicular approach, which involves accessing the vertebral body through a small incision. Under fluoroscopic guidance, a trocar is inserted to facilitate access to the vertebral body. A curved cannula assembly is then utilized to create a tunnel through the vertebral body, allowing for precise targeting of the basivertebral nerve. To enhance the channel to the nerve, a straight channeling stylet may be employed if necessary. The final step involves the use of a bipolar radiofrequency probe connected to a generator, which applies thermal energy to the basivertebral nerve, effectively destroying it and interrupting the transmission of pain signals. This procedure is particularly relevant for patients suffering from chronic low back pain that has not responded to conservative treatments. The CPT® code 64629 is specifically designated for reporting the thermal destruction of each additional lumbar or sacral vertebral body beyond the first two, which are reported using CPT® code 64628.