Coding Paravertebral Facet Joint Destruction
Coding for paravertebral facet joint destruction is based on destruction of the sensory innervation to each facet joint, not per facet joint nerve. CPT Assistant (Feb. 2015) says:
Although two nerves innervate each facet joint, the number of nerves treated does not affect code selection. This is reflected in the term “nerve(s)” which is included in the code descriptors. Therefore, only one unit of service may be reported for each joint regardless of the number of nerves treated. To clarify, the typical patient has two nerves treated for each facet joint. These nerves are at two different vertebral levels; however, the code is re-ported once per joint treated no matter how many nerves are treated.
Relevant codes include:
- 64633 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint
- +64634 … each additional facet joint (List separately in addition to code for primary procedure)
- 64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint
- +64636 … each additional facet joint (List separately in addition to code for primary procedure)
Image guidance (fluoroscopy or CT) is required, and is not separately billable with either 77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) or 77012 Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation. Facet joint nerve destruction is a unilateral procedures, and you may append modifier 50 Bilateral procedure for bilateral facet joint nerve destruction.
For example, to describe radiofrequency ablation of the C3, C4, C5 medial branches, you would report 64633, 64634 because the sensory innervation to two facet joint levels, C3-C4 and C4-C5, was neurolysed. For bilateral L3-L4, L4-L5 and L5-S1 facet joint neurolysis, i.e. L2, L3 and L4 medial branch and L5 dorsal ramus, correct coding would be 64635-50, 64636-50 x 2 units of service (or, depending on your payer, 64635-LT Left side, 64635-RT Right side and 64636-LT x 2, 64636-RT x 2).