How To Use CPT Code 64634

CPT 64634 describes the destruction of the facet joint nerve(s) using a neurolytic agent, with the guidance of imaging such as fluoroscopy or CT scan. 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 64634?

CPT 64634 can be used to describe the destruction of the facet joint nerve(s) using a neurolytic agent, with the guidance of imaging such as fluoroscopy or CT scan. This code is used when the provider performs an additional facet joint injection after the initial neurolytic injection, targeting the cervical or thoracic spinal segment.

2. Official Description

The official description of CPT code 64634 is: ‘Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure).’ This code should be used in conjunction with CPT code 64633, and for bilateral procedures, it should be reported twice without modifier 50.

3. Procedure

1. The provider preps and anesthetizes the patient for an additional facet joint injection after the initial neurolytic injection.
2. Using imaging guidance, such as fluoroscopy or CT scan, the provider inserts a needle through the skin and advances it to the proper position within the cervical or thoracic facet joint.
3. The provider identifies the specific nerve to be destroyed and utilizes various techniques, such as thermal, electric, chemical, or radiofrequency, to destroy the affected nerve root.
4. After the destruction of the nerve root, the provider removes the needle and ensures hemostasis at the site.

4. Qualifying circumstances

CPT 64634 is performed on patients who require the destruction of the facet joint nerve(s) for the treatment of spinal pain. The procedure targets the cervical or thoracic paravertebral facet joint nerve(s) and is guided by imaging, such as fluoroscopy or CT scan.

5. When to use CPT code 64634

CPT code 64634 should be used when the provider performs an additional facet joint injection after the initial neurolytic injection, targeting the cervical or thoracic spinal segment. It is important to note that this code is an add-on code and should be reported in conjunction with CPT code 64633.

6. Documentation requirements

To support a claim for CPT 64634, the provider must document the following information:

• Indication for the procedure and the need for destruction of the facet joint nerve(s)
• Imaging guidance used, such as fluoroscopy or CT scan
• Date of the procedure
• Specific facet joint targeted
• Techniques utilized for the destruction of the nerve root
• Confirmation of hemostasis at the site

7. Billing guidelines

When billing for CPT 64634, ensure that the procedure is performed by a qualified provider and that the additional facet joint injection is guided by imaging, such as fluoroscopy or CT scan. It is important to report this code in conjunction with CPT code 64633. Modifier 50 should not be used for bilateral procedures.

8. Historical information

CPT 64634 was added to the Current Procedural Terminology system on January 1, 2012. There have been no updates to the code since its addition.

9. Examples

1. A patient with chronic cervical spinal pain undergoes an initial facet joint neurolytic injection (CPT 64633) followed by an additional facet joint injection (CPT 64634) targeting the cervical region.
2. A provider performs an initial facet joint neurolytic injection (CPT 64633) on a patient with thoracic spinal pain. In the same session, the provider administers an additional facet joint injection (CPT 64634) targeting the thoracic region.
3. After an initial facet joint neurolytic injection (CPT 64633), a patient with cervical spinal pain receives an additional facet joint injection (CPT 64634) guided by fluoroscopy.
4. A provider performs an initial facet joint neurolytic injection (CPT 64633) on a patient with thoracic spinal pain. In a separate session, the provider administers an additional facet joint injection (CPT 64634) targeting the thoracic region.
5. Following an initial facet joint neurolytic injection (CPT 64633), a patient with chronic cervical spinal pain undergoes an additional facet joint injection (CPT 64634) guided by CT scan.
6. A provider performs an initial facet joint neurolytic injection (CPT 64633) on a patient with thoracic spinal pain. During the same session, the provider administers an additional facet joint injection (CPT 64634) targeting the thoracic region.
7. After an initial facet joint neurolytic injection (CPT 64633), a patient with cervical spinal pain receives an additional facet joint injection (CPT 64634) guided by fluoroscopy.
8. A provider performs an initial facet joint neurolytic injection (CPT 64633) on a patient with thoracic spinal pain. In a separate session, the provider administers an additional facet joint injection (CPT 64634) targeting the thoracic region.