It is confusing, I have a cheat sheet our practice has developed to assist if you want to email me your personal email I will share it with you.
You bill the S1 nerve with the 64623 as it is an additional "segment" if you have a L5 injection (64622) at the same session. Each following SX never should use the 64640 and (S2, S3, S4, S5) as these are not main nerves like medial nerves.
CPT Asst March 2009
64622Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level
64623lumbar or sacral, each additional level (List separately in addition to code for primary procedure)
(Use code 64623 in conjunction with code 64622)
CPT code 64622 describes destruction of a paravertebral facet joint nerve by a neurolytic agent (eg, chemical, thermal, electrical, radiofrequency) at the lumbar or sacral regions of the spine. CPT code 64622 is to be used to report destruction by a neurolytic agent at a single level. Therefore, if destruction by a neurolytic agent is performed at more than one lumbar or sacral level, CPT code 64623 would be reported for each additional lumbar or sacral level. Since 64623 is an add-on code, and exempt from the multiple procedure concept, code 64623 would be reported in addition to code 64622 without appending modifier -51.
It could be different for other practices, so beware.
