CPT® Code 64636

Add-On Code

Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure)

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 spinal movement and stability. The procedure described by CPT® Code 64636 involves the destruction of the paravertebral facet joint nerve(s) 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 lumbar or sacral regions of the 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, glycerol, ammonium salt compounds, or hypertonic solutions. Additionally, thermal or electrical modalities may be employed, where a probe or electrode is used to generate heat that effectively destroys the targeted nerve tissue. This procedure is performed for each additional lumbar or sacral facet joint nerve, and it is important to note that CPT® Code 64636 is used in conjunction with the primary procedure code for accurate billing and documentation.