Look at Nerve Injected When Coding Destruction by Neurolytic Agent
Refer to 64600-64647 for a complete list of these codes. Destruction sounds intense, but destruction by neurolytic agent procedures only destroy tissue that causes pain or other unwanted symptoms for the patient. As for the neurolytic agent component, providers use chemicals, thermal or electrical energy, or radio waves to destroy the nerves responsible for carrying pain signals. The CPT® code range 64600-64647 covers destruction by neurolytic agent (e.g., chemical, thermal, electrical, or radiofrequency) procedures on the somatic nerves. Read on to familiarize yourself with these codes and improve your coding skills for these procedures. Understand Why Providers Use Neurolytic Agents For patients with back or neck pain, migraines, or chronic conditions like trigeminal neuralgia, nerve destruction can relieve pain. When a provider injects a neurodestructive agent at or near the trigeminal nerve, patients with trigeminal neuralgia lose some sensation and motor function in the face and scalp, but they will also experience relief from the excruciating pain associated with their condition. In patients with muscle pain, providers may inject a chemical like Botox into the muscle to alleviate pain and spasms. In addition to chemical agents, providers also use heat, electricity, and radio waves to destroy offending nerve tissue. For example, CPT® code 64625 (Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)) covers destruction via radiofrequency ablation of the nerves that supply the sacroiliac joint. In this procedure, providers use the heat from focused radio waves to destroy abnormal, damaged, or diseased tissue. Use These Tips for Coding Destruction by Neurolytic Agent Here are a few pointers on what to look for to complete your destruction by neurolytic agent encounters: Look out for add-on procedure codes: For example, 64633 (Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint) covers destruction of a single facet joint nerve of a cervical or thoracic spinal segment with a neurolytic agent. If the provider injects more than one facet joint level, use the add-on code +64634 (… cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure)) for each additional injection. Check to see if the procedure is bilateral: Generally, laterality is not a factor for CPT® codes 64600-64632. However, it can come into play with other codes in this section. Let’s stick with the example of injecting a segment of the cervical or thoracic spine to see how laterality can affect coding nerve destruction procedures. If the provider performs the procedure covered by 64633 bilaterally, use modifier 50 (Bilateral procedure) to indicate that it was a bilateral procedure. Keep in mind that every set of bilateral injections on the same level counts as one level, not two. So, if the patient receives bilateral injections on one level, use 64633 with modifier 50. If they receive bilateral injections on more than one facet joint level, use 64633 with modifier 50 appended and +64634. Do not append modifier 50 to +64634 or other add-on codes; when you apply modifier 50 to 64633, payers assume that the provider also performed bilateral injections on the additional levels. Know whether imaging guidance is included in the CPT® code: Sometimes, providers use imaging guidance during nerve destruction procedures. As a result, some of the codes in the 64600-64647 range already have use of imaging guidance built in. For example, use 64624 (Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed) when a provider destroys branches of the nerves that supply the knee joint with a chemical, thermal, or radiofrequency agent. This code includes imaging guidance, so do not bill imaging guidance separately if the provider uses it during the procedure. Unlike 64624, 64600 (Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch) does not include imaging guidance. If you need to use 64600 and the provider used imaging guidance like fluoroscopy or CT to guide the needle placement, add on the appropriate code for the imaging. For example, if the provider used fluoroscopy, add CPT® code +77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (List separately in addition to code for primary procedure)). Don’t rely on the type of neurolytic agent the provider used to find the correct code: Coders who are unfamiliar with the 64600-64647 code range may assume that the best way to navigate the code set is to reference the neurolytic agent type first, but that is not the case. In fact, some codes like 64620 (Destruction by neurolytic agent, intercostal nerve) can involve any type of agent. Instead, refer to the nerve involved in the procedure to find the best applicable code. Here’s a look at which codes correspond to which nerves: Michelle Falci, BA, M Falci Communications LLC
