How To Use CPT Code 64628

CPT 64628 refers to the thermal destruction of intraosseous basivertebral nerve, including all imaging guidance, for the first two lumbar or sacral vertebral bodies. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 64628 procedures.

1. What is CPT 64628?

CPT 64628 is a medical procedure code used to describe the thermal destruction of intraosseous basivertebral nerve, including all imaging guidance, for the first two lumbar or sacral vertebral bodies. This procedure is typically performed to treat chronic lower back pain caused by damaged basivertebral nerves.

2. 64628 CPT code description

The official description of CPT code 64628 is: “Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral.”

3. Procedure

The 64628 procedure involves the following steps:

  1. The patient is appropriately prepped and anesthetized.
  2. Using imaging guidance, the provider inserts a specialized cannula and guides it through the vertebral pedicle.
  3. The cannula creates a tunnel to the basivertebral nerve trunk.
  4. A heating tool, such as a radiofrequency probe, is placed into the path to reach the nerve.
  5. The provider uses the tool to ablate (destroy) the basivertebral nerve of the vertebral endplate.
  6. The procedure is performed on the first two lumbar or sacral vertebral bodies treated at a session.

4. Qualifying circumstances

Patients eligible to receive CPT code 64628 services are those experiencing chronic lower back pain due to damaged basivertebral nerves. The provider must determine that the patient’s pain is caused by the basivertebral nerves and that other conservative treatments have been unsuccessful in providing relief. Additionally, the patient must be medically stable and able to tolerate the procedure.

5. When to use CPT code 64628

It is appropriate to bill the 64628 CPT code when the provider performs the thermal destruction of intraosseous basivertebral nerve, including all imaging guidance, for the first two lumbar or sacral vertebral bodies. This code should be used when the procedure is performed to treat chronic lower back pain caused by damaged basivertebral nerves and when other conservative treatments have been unsuccessful.

6. Documentation requirements

To support a claim for CPT 64628, the following information should be documented:

  • Patient’s medical history and physical examination findings
  • Diagnosis of chronic lower back pain caused by damaged basivertebral nerves
  • Failed conservative treatments and their duration
  • Details of the procedure, including imaging guidance used and the vertebral bodies treated
  • Post-procedure care instructions and follow-up plan

7. Billing guidelines

When billing for CPT code 64628, it is essential to follow the appropriate guidelines and rules. Ensure that the patient’s medical record contains all necessary documentation to support the claim, as outlined in the documentation requirements section. Additionally, be aware of any payer-specific rules or requirements that may apply to the billing of this code. If more than two vertebral bodies are treated during the same session, use the add-on code +64629 for each additional vertebral body.

8. Historical information

CPT 64628 was added to the Current Procedural Terminology system on January 1, 2022. There have been no updates to the code since its addition.

9. Similar codes to CPT 64628

Five similar codes to CPT 64628 include:

  • CPT 64622: Destruction of a paravertebral facet joint nerve, lumbar or sacral, single level
  • CPT 64623: Destruction of a paravertebral facet joint nerve, cervical or thoracic, single level
  • CPT 64626: Destruction of a paravertebral facet joint nerve, lumbar or sacral, each additional level
  • CPT 64627: Destruction of a paravertebral facet joint nerve, cervical or thoracic, each additional level
  • +64629: 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)

These codes differ from CPT 64628 in the specific nerves targeted, the number of vertebral levels treated, and the type of procedure performed.

10. Examples

Here are 10 detailed examples of CPT code 64628 procedures:

  1. A 45-year-old patient with chronic lower back pain due to damaged basivertebral nerves undergoes thermal destruction of the intraosseous basivertebral nerve in the L4 and L5 vertebral bodies.
  2. A 60-year-old patient with a history of failed conservative treatments for lower back pain receives thermal destruction of the intraosseous basivertebral nerve in the S1 and S2 vertebral bodies.
  3. A 35-year-old patient with chronic lower back pain undergoes thermal destruction of the intraosseous basivertebral nerve in the L3 and L4 vertebral bodies, guided by fluoroscopy.
  4. A 50-year-old patient with persistent lower back pain undergoes thermal destruction of the intraosseous basivertebral nerve in the L5 and S1 vertebral bodies, guided by computed tomography (CT).
  5. A 55-year-old patient with chronic lower back pain due to damaged basivertebral nerves undergoes thermal destruction of the intraosseous basivertebral nerve in the L2 and L3 vertebral bodies, guided by magnetic resonance imaging (MRI).
  6. A 40-year-old patient with a history of failed conservative treatments for lower back pain receives thermal destruction of the intraosseous basivertebral nerve in the L1 and L2 vertebral bodies, guided by ultrasound.
  7. A 65-year-old patient with chronic lower back pain undergoes thermal destruction of the intraosseous basivertebral nerve in the S2 and S3 vertebral bodies, guided by fluoroscopy.
  8. A 70-year-old patient with persistent lower back pain undergoes thermal destruction of the intraosseous basivertebral nerve in the S3 and S4 vertebral bodies, guided by CT.
  9. A 75-year-old patient with chronic lower back pain due to damaged basivertebral nerves undergoes thermal destruction of the intraosseous basivertebral nerve in the S4 and S5 vertebral bodies, guided by MRI.
  10. A 30-year-old patient with a history of failed conservative treatments for lower back pain receives thermal destruction of the intraosseous basivertebral nerve in the L5 and S1 vertebral bodies, guided by ultrasound.

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