How To Use CPT Code 64640

CPT 64640 refers to the destruction of peripheral nerves or branches by neurolytic agents, and this article will cover its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 64640?

CPT 64640 is a medical procedure code that describes the destruction of peripheral nerves or branches by neurolytic agents. This procedure is typically performed to alleviate chronic pain by destroying the nerves responsible for transmitting pain signals. The code is used by medical coders and billers to accurately document and bill for this specific procedure.

2. 64640 CPT code description

The official description of CPT code 64640 is: “Destruction by neurolytic agent; other peripheral nerve or branch.”

3. Procedure

The 64640 procedure involves the following steps:

1. Identification of the target nerve or nerve branch responsible for transmitting pain signals.
2. Administration of local anesthesia to numb the area surrounding the target nerve.
3. Injection of a neurolytic agent, such as alcohol or phenol, to destroy the nerve or nerve branch.
4. Monitoring the patient for any adverse reactions or complications.
5. Assessment of pain relief following the procedure.

4. Qualifying circumstances

Patients eligible to receive CPT code 64640 services are those who:

• Experience chronic pain that has not responded to conservative treatments, such as medications, physical therapy, or nerve blocks.
• Have a clear diagnosis of a peripheral nerve or nerve branch as the source of their pain.
• Are not candidates for surgical intervention or have failed previous surgical treatments.
• Do not have contraindications to the use of neurolytic agents, such as allergies or severe medical conditions.

5. When to use CPT code 64640

It is appropriate to bill the 64640 CPT code when a qualified healthcare provider performs the destruction of a peripheral nerve or nerve branch using a neurolytic agent to alleviate chronic pain that has not responded to other treatments. The provider must have a clear diagnosis of the nerve or nerve branch as the source of the patient’s pain and have determined that the patient is an appropriate candidate for the procedure.

6. Documentation requirements

To support a claim for CPT 64640, the following information should be documented:

• Patient’s medical history, including previous treatments and their outcomes.
• Physical examination findings, including the location and severity of pain.
• Diagnostic tests or imaging studies that confirm the peripheral nerve or nerve branch as the source of pain.
• Indications for the procedure, including the rationale for using a neurolytic agent.
• Details of the procedure, including the type of neurolytic agent used, the target nerve or nerve branch, and any complications or adverse reactions.
• Post-procedure assessment of pain relief and any follow-up care or recommendations.

7. Billing guidelines

When billing for CPT code 64640, it is essential to follow the appropriate guidelines and rules. Some tips and codes that apply to CPT code 64640 include:

• Report fluoroscopic guidance separately, if used during the procedure.
• Ensure that the patient’s medical record contains all necessary documentation to support the claim, as outlined in the documentation requirements section.
• Verify that the patient meets the qualifying circumstances for the procedure.
• Be aware of any payer-specific guidelines or requirements for billing CPT code 64640.

8. Historical information

CPT 64640 was added to the Current Procedural Terminology system on January 1, 1990. The code has undergone changes since its addition, with the most recent change occurring on January 1, 2001, when the previous descriptor was updated to its current form.

9. Similar codes to CPT 64640

Five similar codes to CPT 64640 and how they differ are:

• CPT 64633: Destruction of a paravertebral facet joint nerve, single level, cervical or thoracic region.
• CPT 64634: Destruction of a paravertebral facet joint nerve, each additional level, cervical or thoracic region.
• CPT 64635: Destruction of a paravertebral facet joint nerve, single level, lumbar or sacral region.
• CPT 64636: Destruction of a paravertebral facet joint nerve, each additional level, lumbar or sacral region.
• CPT 64642: Destruction of a peripheral nerve or branch using chemodenervation, such as for the treatment of hyperhidrosis or muscle spasticity.

10. Examples

Here are 10 detailed examples of CPT code 64640 procedures:

1. Destruction of the ilioinguinal nerve for chronic groin pain following hernia repair.
2. Neurolysis of the intercostal nerves for persistent pain after thoracic surgery.
3. Destruction of the genicular nerves for chronic knee pain that has not responded to other treatments.
4. Neurolysis of the lateral femoral cutaneous nerve for meralgia paresthetica.
5. Destruction of the occipital nerves for chronic occipital neuralgia.
6. Neurolysis of the suprascapular nerve for persistent shoulder pain after rotator cuff surgery.
7. Destruction of the saphenous nerve for chronic pain following knee replacement surgery.
8. Neurolysis of the pudendal nerve for chronic pelvic pain.
9. Destruction of the sural nerve for persistent pain after ankle surgery.
10. Neurolysis of the medial branch nerves for chronic low back pain that has not responded to other treatments.