How To Use CPT Code 64635

CPT 64635 refers to the destruction of paravertebral facet joint nerve(s) by a neurolytic agent, with imaging guidance in the lumbar or sacral region. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 64635 procedures.

1. What is CPT 64635?

CPT 64635 is a medical procedure code used to describe the destruction of paravertebral facet joint nerve(s) in the lumbar or sacral region of the spine by a neurolytic agent, with the assistance of imaging guidance such as fluoroscopy or computed tomography (CT). This procedure is typically performed to alleviate chronic pain caused by facet joint arthritis or other spinal conditions.

2. 64635 CPT code description

The official description of CPT code 64635 is: “Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint.”

3. Procedure

The 64635 procedure involves the following steps:

  1. The patient is positioned and anesthetized.
  2. Fluoroscopy or CT guidance is used to direct a needle to the affected joint in the lumbar or sacral area of the spine.
  3. The provider identifies the nerves and confirms the needle is in the appropriate location.
  4. A neurolytic agent, such as radiofrequency, is applied to destroy the targeted nerve(s).
  5. The provider may treat one or more nerves on a single side of a single joint.
  6. The needle is removed, and a dressing is applied to the site.

4. Qualifying circumstances

Patients eligible to receive CPT code 64635 services are those experiencing chronic pain due to facet joint arthritis or other spinal conditions affecting the lumbar or sacral region. The procedure is typically recommended when conservative treatments, such as physical therapy, medications, or injections, have failed to provide adequate pain relief. A thorough evaluation, including imaging studies and diagnostic nerve blocks, is usually performed to confirm the source of pain and determine the appropriateness of the procedure.

5. When to use CPT code 64635

It is appropriate to bill the 64635 CPT code when the provider performs the destruction of paravertebral facet joint nerve(s) in the lumbar or sacral region using a neurolytic agent, with imaging guidance. The procedure should be performed only after a thorough evaluation and when conservative treatments have failed to provide adequate pain relief.

6. Documentation requirements

To support a claim for CPT 64635, the following information should be documented:

  • Patient’s medical history and physical examination findings
  • Diagnostic imaging studies and nerve block results
  • Conservative treatments attempted and their outcomes
  • Indications for the procedure
  • Details of the procedure, including the type of imaging guidance used, the neurolytic agent applied, and the number of nerves treated
  • Post-procedure findings and patient’s response to the treatment
  • Follow-up care plan

7. Billing guidelines

When billing for CPT code 64635, keep in mind the following guidelines and tips:

  • Each facet joint is considered a single unit of service for this code.
  • This code represents a unilateral service. Payer rules for reporting a bilateral service may vary. Some may ask you to report a single line item with modifier 50, while others may ask you to report two line items with modifier RT on one and modifier LT on the other.
  • For bilateral procedures, report 64635 with modifier 50.

8. Historical information

CPT 64635 was added to the Current Procedural Terminology system on January 1, 2012. There have been no updates to the code since its addition.

9. Similar codes to CPT 64635

Five similar codes to CPT 64635 and how they differ are:

  1. CPT 64633: Destruction of cervical or thoracic facet joint nerve(s) instead of lumbar or sacral.
  2. CPT 64636: Destruction of additional lumbar or sacral facet joint nerve(s) during the same session.
  3. CPT 64634: Destruction of additional cervical or thoracic facet joint nerve(s) during the same session.
  4. CPT 64493: Injection of anesthetic agent or steroid into the lumbar or sacral facet joint, rather than destruction of the nerve(s).
  5. CPT 64494: Injection of anesthetic agent or steroid into additional lumbar or sacral facet joint(s) during the same session.

10. Examples

Here are 10 detailed examples of CPT code 64635 procedures:

  1. A patient with chronic low back pain due to lumbar facet joint arthritis undergoes radiofrequency ablation of the left L4-L5 facet joint nerve under fluoroscopic guidance.
  2. A patient with sacroiliac joint pain undergoes CT-guided neurolytic destruction of the right S1-S2 facet joint nerve using radiofrequency ablation.
  3. A patient with lumbar spinal stenosis and facet joint arthritis undergoes radiofrequency ablation of the bilateral L3-L4 facet joint nerves under fluoroscopic guidance (modifier 50 should be used).
  4. A patient with failed back surgery syndrome undergoes fluoroscopic-guided radiofrequency ablation of the left L5-S1 facet joint nerve.
  5. A patient with lumbar spondylolisthesis and facet joint arthritis undergoes CT-guided neurolytic destruction of the right L2-L3 facet joint nerve using radiofrequency ablation.
  6. A patient with lumbar degenerative disc disease and facet joint arthritis undergoes fluoroscopic-guided radiofrequency ablation of the left L1-L2 facet joint nerve.
  7. A patient with lumbar facet joint hypertrophy undergoes CT-guided neurolytic destruction of the right L4-L5 and L5-S1 facet joint nerves using radiofrequency ablation (CPT 64635 for the first joint and CPT 64636 for the additional joint).
  8. A patient with lumbar radiculopathy and facet joint arthritis undergoes fluoroscopic-guided radiofrequency ablation of the left L3-L4 facet joint nerve.
  9. A patient with lumbar spondylosis and facet joint arthritis undergoes CT-guided neurolytic destruction of the right L5-S1 facet joint nerve using radiofrequency ablation.
  10. A patient with chronic low back pain due to lumbar facet joint arthritis undergoes radiofrequency ablation of the bilateral L2-L3 facet joint nerves under fluoroscopic guidance (modifier 50 should be used).

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