How To Use CPT Code 64636

CPT 64636 refers to the destruction of paravertebral facet joint nerve(s) in the lumbar or sacral region using neurolytic agents and imaging guidance. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 64636 procedures.

1. What is CPT 64636?

CPT 64636 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. This procedure is performed using neurolytic agents, such as heat, electric current, or chemical compounds, and is guided by imaging techniques like fluoroscopy or CT scans. The primary goal of this procedure is to treat spinal pain caused by the affected nerve(s).

2. 64636 CPT code description

The official description of CPT code 64636 is: “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).”

3. Procedure

The 64636 procedure involves the following steps:

1. Preparation and anesthesia of the patient for an additional facet joint injection after the initial, separately reportable single facet joint neurolytic injection.
2. Insertion of the needle through the skin and advancement to the proper position within the lumbar or sacral facet joint, using fluoroscopy or CT image guidance.
3. Identification of the exact nerve to be destroyed.
4. Application of a single technique or a combination of techniques, such as thermal, electric, chemical, and radiofrequency, to destroy the affected nerve root.
5. Removal of the needle and ensuring hemostasis at the site.

4. Qualifying circumstances

Patients eligible to receive CPT code 64636 services are those experiencing spinal pain due to the affected nerve(s) in the lumbar or sacral region. The pain should be unresponsive to conservative treatments, such as medication, physical therapy, or other non-invasive methods. The provider must determine that the destruction of the paravertebral facet joint nerve(s) is the most appropriate course of action to alleviate the patient’s pain.

5. When to use CPT code 64636

It is appropriate to bill the 64636 CPT code when the provider performs the destruction of paravertebral facet joint nerve(s) in the lumbar or sacral region using neurolytic agents and imaging guidance, and the patient meets the qualifying circumstances mentioned above. This code is an add-on code and should be used in conjunction with the primary code 64635. It represents a unilateral service, and for bilateral procedures, the code should be reported twice without using modifier 50.

6. Documentation requirements

To support a claim for CPT 64636, the following information should be documented:

• Patient’s medical history and physical examination findings, including the presence of spinal pain in the lumbar or sacral region.
• Conservative treatments attempted and their outcomes.
• Provider’s decision to perform the destruction of paravertebral facet joint nerve(s) as the most appropriate course of action.
• Detailed description of the procedure, including the techniques used, imaging guidance, and the specific nerve(s) targeted.
• Post-procedure care and follow-up plan.

7. Billing guidelines

When billing for CPT code 64636, keep in mind the following guidelines:

• Use 64636 in conjunction with the primary code 64635.
• For bilateral procedures, report 64636 twice without using modifier 50.
• Do not report imaging guidance, such as fluoroscopy or CT, separately.
• Do not report 64633-64636 in conjunction with 77003 or 77012.
• For radiofrequency ablation of nerves innervating the sacroiliac joint with image guidance, use code 64625.

8. Historical information

CPT 64636 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 64636

Five similar codes to CPT 64636 and how they differ are:

1. CPT 64633: Destruction of cervical or thoracic facet joint nerve(s) instead of lumbar or sacral.
2. CPT 64634: Destruction of additional cervical or thoracic facet joint nerve(s).
3. CPT 64635: Destruction of lumbar or sacral facet joint nerve(s) for the initial facet joint.
4. CPT 64625: Radiofrequency ablation of nerves innervating the sacroiliac joint with image guidance.
5. CPT 77003: Fluoroscopic guidance for needle placement, not specific to facet joint nerve destruction.

10. Examples

Here are 10 detailed examples of CPT code 64636 procedures:

1. A patient with chronic lumbar pain undergoes destruction of the L4-L5 paravertebral facet joint nerve using radiofrequency ablation and fluoroscopic guidance.
2. A patient with sacral pain undergoes destruction of the S1-S2 paravertebral facet joint nerve using chemical neurolysis and CT guidance.
3. A patient with lumbar pain undergoes destruction of the L3-L4 and L4-L5 paravertebral facet joint nerves using thermal neurolysis and fluoroscopic guidance.
4. A patient with lumbar pain undergoes destruction of the L5-S1 paravertebral facet joint nerve using electric neurolysis and CT guidance.
5. A patient with sacral pain undergoes destruction of the S2-S3 paravertebral facet joint nerve using radiofrequency ablation and fluoroscopic guidance.
6. A patient with lumbar pain undergoes destruction of the L2-L3 paravertebral facet joint nerve using chemical neurolysis and CT guidance.
7. A patient with lumbar pain undergoes destruction of the L1-L2 paravertebral facet joint nerve using thermal neurolysis and fluoroscopic guidance.
8. A patient with sacral pain undergoes destruction of the S3-S4 paravertebral facet joint nerve using electric neurolysis and CT guidance.
9. A patient with lumbar pain undergoes destruction of the L3-L4 and L5-S1 paravertebral facet joint nerves using radiofrequency ablation and fluoroscopic guidance.
10. A patient with sacral pain undergoes destruction of the S4-S5 paravertebral facet joint nerve using chemical neurolysis and CT guidance.