Neurology & Pain Management Coding Alert

Question: Coding instructions in CPT® state that when you bill 64636 you should "code first" 64635. I'm not sure it's correct to bill two primary level codes (such as 64633 and 64635) for the procedure. Can you clarify how to handle this?

Connecticut Subscriber

Answer: You should consider two factors when coding paravertebral facet joint nerve destruction: the facet joint level treated and single versus multiple destructions to that level.

When the physician destroys the paravertebral facet joint nerves that innervate a cervical or thoracic joint, report 64633 (Destruction by neurolytic agent, paravertebral facet joint nerve[s] with imaging guidance [fluoroscopy or CT]; cervical or thoracic, single facet joint) for the initial (first level) destruction. Add +64634 (...each additional facet joint [List separately in addition to code for primary procedure]) for each additional cervical or thoracic level the physician destroys during that encounter.

For the lumbar or sacral spinal region, start with 64635 (Destruction by neurolytic agent, paravertebral facet joint nerve[s] with imaging guidance [fluoroscopy or CT]; lumbar or sacral, single facet joint) for the initial destruction. Add +64636 (... lumbar or sacral, each additional facet joint [List separately in addition to code for primary procedure]) for each additional level.

The "code first" reference you mention relates to the fact that codes 64635 and +64636 both address destruction at the lumbar/sacral levels. You must report a destruction with 64635 before you can report additional destructions with +64636. The same holds true for cervical/thoracic codes 64633 and +64634.

Multiple primary codes: If your physician destroys nerves at both the cervical/thoracic and lumbar/sacral levels, you can report both primary codes 64633 and 64635. Per the NCCI edits, there are no bundling edits between the two primary codes.