How To Use CPT Code 64681

CPT 64681 describes the destruction of the superior hypogastric plexus using a neurolytic agent, with or without radiologic monitoring. 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 64681?

CPT 64681 can be used to describe the destruction of the superior hypogastric plexus, a bundle of nerves that innervates the lower pelvic organs and genitalia. This procedure involves injecting a neurolytic agent into the plexus to destroy part of the nerve and reduce pelvic pain. It is typically performed for conditions such as malignancy or endometriosis. The provider may use imaging guidance during the procedure to ensure accurate placement of the needle.

2. Official Description

The official description of CPT code 64681 is: ‘Destruction by neurolytic agent, with or without radiologic monitoring; superior hypogastric plexus.’

3. Procedure

1. The provider prepares the patient and administers anesthesia.
2. Using X-ray or CT guidance, the provider inserts a needle through the patient’s skin and muscles at the L5/S1 interspace.
3. If imaging guidance is used, the provider confirms the needle position by injecting contrast and aspirating for fluids.
4. Once the needle position is confirmed, the provider injects the neurolytic agent into the superior hypogastric plexus.
5. The neurolytic agent destroys part of the nerve, reducing pelvic pain.
6. The provider may use radiologic monitoring during the procedure to ensure accurate placement of the needle.

4. Qualifying circumstances

CPT 64681 is performed for patients with conditions such as malignancy or endometriosis that cause pelvic pain. The procedure targets the superior hypogastric plexus, which is part of the thoracolumbar sympathetic chain of the autonomic nervous system. It is important to note that this procedure should only be performed by a qualified healthcare professional with the necessary expertise.

5. When to use CPT code 64681

CPT code 64681 should be used when the provider performs the destruction of the superior hypogastric plexus using a neurolytic agent. It is important to ensure that the procedure is documented accurately and that the medical necessity for the procedure is clearly established.

6. Documentation requirements

To support a claim for CPT 64681, the provider must document the following information:

• Patient’s diagnosis and the medical necessity for the procedure
• Details of the procedure, including the use of anesthesia and imaging guidance
• Date and duration of the procedure
• Specific neurolytic agent used
• Confirmation of needle position and any radiologic monitoring performed
• Any complications or adverse events
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 64681, it is important to ensure that the procedure is performed by a qualified healthcare professional and that the documentation supports the medical necessity of the procedure. If radiologic monitoring is performed, it should be reported separately. It is also important to follow any specific billing guidelines provided by the payer.

8. Historical information

CPT 64681 was added to the Current Procedural Terminology system on January 1, 2004. There have been no updates to the code since its addition.

9. Examples

1. A patient with endometriosis undergoes the destruction of the superior hypogastric plexus to alleviate pelvic pain.
2. A provider performs the destruction of the superior hypogastric plexus using a neurolytic agent for a patient with malignancy-related pelvic pain.
3. The superior hypogastric plexus is targeted and destroyed using a neurolytic agent to reduce pelvic pain in a patient with a history of chronic pelvic pain.
4. A provider performs the destruction of the superior hypogastric plexus using a neurolytic agent for a patient with refractory pelvic pain.
5. A patient with endometriosis-related pelvic pain undergoes the destruction of the superior hypogastric plexus to improve their quality of life.
6. The provider performs the destruction of the superior hypogastric plexus using a neurolytic agent for a patient with advanced malignancy and severe pelvic pain.
7. A patient with chronic pelvic pain undergoes the destruction of the superior hypogastric plexus to alleviate their symptoms and improve their daily functioning.
8. The provider performs the destruction of the superior hypogastric plexus using a neurolytic agent for a patient with intractable pelvic pain.
9. A patient with endometriosis-related pelvic pain undergoes the destruction of the superior hypogastric plexus to reduce their reliance on pain medications.
10. The provider performs the destruction of the superior hypogastric plexus using a neurolytic agent for a patient with refractory pelvic pain who has failed conservative treatments.