How To Use CPT Code 64620

CPT 64620 describes the destruction of the intercostal nerve using a neurolytic agent, such as a chemical, heat, or radiofrequency technique. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 64620?

CPT 64620 can be used to describe the destruction of the intercostal nerve using a neurolytic agent. This code is used when a healthcare provider uses a chemical, heat, or radiofrequency technique to destroy the intercostal nerve, which is responsible for carrying pain information. Intercostal nerve blocks are commonly used for bone pain or neuralgia.

2. Official Description

The official description of CPT code 64620 is: ‘Destruction by neurolytic agent, intercostal nerve.’

3. Procedure

1. The patient is placed in a prone position.
2. The healthcare provider uses fluoroscopic imaging to guide the placement of a needle into the body, specifically to the lower border of the selected rib.
3. After ensuring there is no aspiration, the provider injects a neurolytic agent, such as phenol or alcohol, into the intercostal nerve to destroy its internal contents while preserving the sheath.
4. Alternatively, the provider may use a radiofrequency, ultrasound, or diathermy probe to destroy the nerve.

4. Qualifying circumstances

CPT 64620 is used for the destruction of the intercostal nerve using a neurolytic agent. This procedure is typically performed for patients experiencing bone pain or neuralgia. It is important to note that imaging guidance, such as fluoroscopy or CT, is inclusive components of CPT codes 64633-64636. If CT or fluoroscopic imaging is not used, report code 64999 instead.

5. When to use CPT code 64620

CPT code 64620 should be used when a healthcare provider performs the destruction of the intercostal nerve using a neurolytic agent. It is important to ensure that the procedure is documented accurately and that the appropriate documentation requirements are met.

6. Documentation requirements

To support a claim for CPT 64620, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for intercostal nerve destruction
• Specific technique used for the destruction (chemical, heat, or radiofrequency)
• Date and details of the procedure, including the use of fluoroscopic imaging if applicable
• Progress made by the patient and any additional sessions scheduled
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 64620, ensure that the procedure is accurately documented and that the appropriate documentation requirements are met. It is important to report fluoroscopic guidance separately if used during the procedure. Additionally, for simple injection of an anesthetic agent or steroid into the intercostal nerve, different codes should be used (64420 for a single level and 64421 for each additional level).

8. Historical information

CPT 64620 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A patient with bone pain undergoes destruction of the intercostal nerve using a neurolytic agent.
2. A healthcare provider performs the destruction of the intercostal nerve using radiofrequency technique for a patient with neuralgia.
3. Using fluoroscopic imaging, a provider destroys the intercostal nerve with a chemical agent for a patient experiencing chronic pain.
4. A patient with bone metastasis receives intercostal nerve destruction using a heat technique to alleviate pain.
5. A healthcare provider uses a neurolytic agent to destroy the intercostal nerve for a patient with post-herpetic neuralgia.
6. Using ultrasound guidance, a provider performs the destruction of the intercostal nerve with a radiofrequency technique for a patient with rib fracture pain.
7. A patient with intercostal neuralgia undergoes destruction of the intercostal nerve using a chemical agent.
8. A healthcare provider performs the destruction of the intercostal nerve using a heat technique for a patient with chronic chest wall pain.
9. Using fluoroscopic imaging, a provider destroys the intercostal nerve with a radiofrequency technique for a patient with post-thoracotomy pain syndrome.
10. A patient with rib fracture pain receives intercostal nerve destruction using a neurolytic agent.