CPT® Code 64633

Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint

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. These joints play a significant role in providing stability and facilitating movement in the spine. The procedure described by CPT® Code 64633 involves the destruction of the paravertebral facet joint nerve using a neurolytic agent, which is guided by imaging techniques such as fluoroscopy or computed tomography (CT). This intervention is typically performed to alleviate pain associated with conditions affecting the cervical or thoracic spine. The process begins with the preparation of the skin over the facet joint, followed by the administration of a local anesthetic to minimize discomfort during the procedure. A spinal needle is then carefully directed into the facet joint space, and contrast material is injected to confirm the correct positioning of the needle. Once the needle is accurately placed, a neurolytic agent is injected to destroy the nerve pathway, which may include substances like phenol, ethyl alcohol, or glycerol. Alternatively, thermal or electrical modalities can be employed, where an electrode is used to generate heat that destroys the targeted nerve tissue. This procedure is specifically coded as 64633 for a single cervical or thoracic facet joint nerve, with additional codes available for multiple levels or different regions of the spine.