How To Use CPT Code 64818

CPT 64818 describes a procedure known as lumbar sympathectomy, which involves the removal or destruction of a portion of the lumbar sympathetic nerve. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 64818?

CPT 64818 is a code used to describe the surgical procedure of lumbar sympathectomy. This procedure involves the removal or destruction of a portion of the lumbar sympathetic nerve, which is part of the sympathetic nerve chain. It is performed to relieve pain or increase blood flow in patients with narrowed blood vessels.

2. Official Description

The official description of CPT code 64818 is: ‘Sympathectomy, lumbar.’ This code is used when the provider removes or destroys a portion of the lumbar sympathetic nerve. If the procedure is performed bilaterally, modifier 50 should be appended to the code.

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision in the patient’s flank to access the lumbar sympathetic nerve chain.
3. The provider carefully identifies and exposes the sympathetic nerve chain, which is a vertical, thick, cord-like structure between the vertebral column and the muscle.
4. The provider dissects the sympathetic nerve chain at the chosen level, being careful to avoid surrounding structures.
5. As the provider dissects the chain, she divides the nerve connections to the ganglion.
6. The provider closes the incised tissue and skin incision to complete the procedure.

4. Qualifying circumstances

Lumbar sympathectomy is performed in patients who require relief from pain or increased blood flow due to narrowed blood vessels. The procedure targets the lumbar sympathetic chain, which consists of four nerve clusters located in the lumbar region. It is important to note that this code represents a unilateral service. If the procedure is performed bilaterally, modifier 50 should be appended to the code.

5. When to use CPT code 64818

CPT code 64818 should be used when a provider performs a lumbar sympathectomy procedure. It is important to ensure that the procedure is performed on the lumbar sympathetic nerve and not on other parts of the sympathetic nerve chain. This code should not be used for procedures involving the cervical sympathetic chain, cervicothoracic, or thoracolumbar regions.

6. Documentation requirements

To support a claim for CPT code 64818, the provider must document the following information:

• Patient’s diagnosis and the medical necessity for the procedure
• Details of the procedure, including the specific lumbar sympathetic nerve targeted
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 64818, ensure that the procedure is performed on the lumbar sympathetic nerve. If the procedure is performed bilaterally, modifier 50 should be appended to the code. It is important to note that this code is not reported with other codes in the 64802-64823 range. Additionally, consider the location of the testing when coding for lumbar sympathectomy.

8. Historical information

CPT code 64818 was added to the Current Procedural Terminology system on January 1, 1990. The code has not undergone any updates since its addition. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A patient with peripheral vascular disease undergoes a lumbar sympathectomy to increase blood flow in the lower extremities.
2. A patient with chronic lower back pain undergoes a lumbar sympathectomy to relieve pain and improve mobility.
3. A patient with Raynaud’s disease undergoes a lumbar sympathectomy to alleviate symptoms and improve blood flow to the affected areas.
4. A patient with complex regional pain syndrome undergoes a lumbar sympathectomy to reduce pain and improve function.
5. A patient with vasospastic disorders undergoes a lumbar sympathectomy to alleviate symptoms and improve blood flow.