cpt 64635, cpt 64633, cpt 64636

Billing Guide For CPT 64633, CPT 64634, CPT 64635 & CPT 64636 | Paravertebral Facet Joint Codes

Paravertebral facet joint procedures can be billed with CPT 64633, CPT 64634, CPT 64635, and CPT 64636. Below are descriptions and billing guidelines for the CPT codes that can be used to report paravertebral facet joint procedures.

Don’t report CPT 64633, CPT 64634, CPT 64635, or CPT 64636 in combination with CPT 77003 or CPT 77012.

CPT 64633

CPT code 64633 is described by the CPT manual as: “Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint.”

Procedure

The goal of the CPT 64633 procedure is to treat spinal pain.

When the patient is appropriately prepped and anesthetized, the provider inserts the needle through the skin and advances it to the proper position within the cervical or thoracic facet joint, the joint connecting two spinal vertebrae together. The health provider uses fluoroscopy or CT imaging guidance.

The health provider then identifies the exact nerve he will destroy and uses the appropriate single technique or combination of techniques, like thermal, electric, chemical, and radiofrequency, to destroy the affected nerve root.

In the radiofrequency method, he uses radio waves that heat an electrode placed on the nerve root, thereby destroying it. This method is also called rhizotomy.

In chemical destruction, he makes use of a chemical substance like alcohol. In the electric method, he uses electric current to burn the nerve root and heat in the thermal method.

The health provider then removes the needle and ensures the site obtains hemostasis. He performs the injection on a single facet joint.

Billing Guidelines

This is a resequenced code, and it represents a unilateral service. Use CPT 64633 with modifier 50 for bilateral procedures.

You should not report imaging guidance, specifically fluoroscopy or CT, separately.

Use CPT code 64999 when the provider performs paravertebral facet joint nerve destruction without CT or fluoro imaging guidance.

CPT 64634

CPT code 64634 is described by the CPT manual as: “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)”

Procedure

The goal of the CPT 64634 procedure is to treat spinal pain.

After the initial facet joint neurolytic injection, the provider preps and anesthetizes the patient for an additional facet joint injection during the same session.

He inserts the needle through the skin and advances it to the proper position within the cervical or thoracic facet joint, the joint connecting two spinal vertebrae together. He uses fluoroscopy or CT imaging guidance.

He then identifies the exact nerve he will destroy. He uses an appropriate single technique or combination of thermal, electric, chemical, and radiofrequency techniques to destroy the affected nerve root. In the radiofrequency method, he uses radio waves that heat an electrode placed on the nerve root, thereby destroying it.

This method is also called rhizotomy. In chemical destruction, he makes use of a chemical substance like alcohol.

In the electric method, he uses electric current to burn the nerve root and heat in the thermal method. He then removes the needle and ensures the site obtains hemostasis.

Billing Guidelines

The 64634 CPT code is an add-on and resequenced code. Use this code in combination with CPT code 64633.

This code represents a unilateral service. Report this code two times for bilateral procedures. You are not allowed to report modifier 50 with this code.

CPT 64634 is an add–on code. Payers will not reimburse you if you report it without an appropriate primary code, CPT 64633.

You should not report imaging guidance, specifically fluoroscopy or CT, separately.

CPT 64635

CPT code 64635 is described by the CPT manual as: “Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint.”

Procedure

Once the patient is anesthetized, the health provider uses fluoroscopy or CT guidance to direct a needle to the affected joint in the lumbar or sacral area of the spine.

He identifies the nerves and confirms the needle is in the appropriate location. The provider then applies the nerve-destroying agent, such as radiofrequency.

The provider may treat one or more nerves on a single side of a single joint. He removes the needle and applies a dressing.

Billing Guidelines

CPT code 64635 is a resequenced code. This code must be reported with modifier 50 if reported for bilateral procedures.

Each facet joint is a single unit of service for this code.

CPT code 64635 represents a unilateral service. Payer rules for reporting a bilateral service may vary.

Some may ask you to report a single line item with modifier 50, while others may ask you to report two line items with modifier RT on one and modifier LT on the other.

CPT 64636

CPT code 64636 is described by the CPT manual as: “Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure).”

Procedure

The goal of the CPT 64636 procedure is to treat spinal pain.

After the initial facet joint neurolytic injection, the provider preps and anesthetizes the patient for an additional facet joint injection during the same session.

He inserts the needle through the skin and advances it to the proper position within the lumbar or sacral facet joint, the joint connecting two spinal vertebrae together. He uses fluoroscopy or CT image guidance.

He then identifies the exact nerve he will destroy. He uses an appropriate single technique or combination of thermal, electric, chemical, and radiofrequency techniques to destroy the affected nerve root.

In the radiofrequency method, he uses radio waves that heat an electrode placed on the nerve root, thereby destroying it.

This method is also called rhizotomy. In chemical destruction, he makes use of a chemical substance like alcohol. In the electric method, he uses electric current to burn the nerve root and heat in the thermal method.

He then removes the needle and ensures the site obtains hemostasis.

Billing Guidelines

Because CPT 64636 is an add–on code, payers will not reimburse you if you report it without an appropriate primary code, CPT 64635.

The 64636 CPT code is an add-on and resequenced code. Use this code in combination with CPT 64636. Report it two times for bilateral procedures. Do not report this code with modifier 60.

Use CPT 64625 for radiofrequency ablation of nerves innervating the sacroiliac joint with image guidance.

This code represents a unilateral service; you should not separately report imaging guidance, specifically fluoroscopy or CT.

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