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How to Code your
Facet Nerve Ablation /
Rhizotomy if Fluoro or
CT is not used for
imaging guidance?
PAIN MANAGEMENT CODING | Facet Nerve RF Ablation / Rhizotomy
(Effective January 2012)

64633         Destruction by neurolytic agent, paravertebral facet joint nerve (s)
with imaging guidance (fluoroscopy or CT); cervical or thoracic; single facet joint
+64634        cervical or thoracic, 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       lumbar or sacral, each additional facet joint (List separately in addition
to code for primary procedure)

Pointers on HOW to PROPERLY USE THESE CODES:

1. These codes are no longer billable at a service unit(s) on a per single nerve at a
single vertebral level;
2. You have to remember that there are 2 spinal nerves that inervates each single
facet joint;
3. Anatomically, there are 2 facet joints (left and right) on each vertebral level;
4. These codes are billable per facet joint; which means, if 2 facet joints were
treated on the same vertebral level, then you will report the primary code with a
modifier -50 to indicate a bilateral procedure;

Here are your number of pairs for your Spinal Nerves: There's a total of 31 pairs.
Cervical     8 pair
Thoracic    12 pair
Lumbar     5 pair
Sacral       5 pair
Coccyx     1 pair

Also note that imaging guidance is inclusive and that per CPT guideline, fluoro or
CT (imaging guidance) is required for the performance of these procedures.

Otherwise,  we are being further instructed that if imaging guidance (Fluoro or CT)
is not used, it is appropriate to use the unlisted procedure code 64499 (Nervous System).

The APRIL 2013 CPT Assistant (Frequently Asked Questions: Nervous System) did
describe the scenario that if an imaging (Fluoro / CT)  is not used on these CPT
Codes, you have to use the unlisted code
64499.



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Sources and References: AMA's CPT Assistant, NCCI Edits from CMS
Website, Highmark Medicare Services LCD, OIG Reports

CPT IS OWNED AND IS A REGISTERED TRADEMARK OF THE
AMERICAN MEDICAL ASSOCIATION.

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CPT Codes 64633, 64634, 64635, 64636

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