Orthopedic Coding Alert

Question: Encounter notes indicate that the surgeon performed destruction of a single paravertebral facet joint by neurolytic agent. The surgeon did not use any visualization for the procedure. We reported 64633 and received a denial. What went wrong?

Washington, DC Subscriber

Answer: Since the surgeon didn’t use visualization for the procedure, you should have reported 64999 (Unlisted procedure, nervous system).

Explanation: The descriptor for 64633 (Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint) specifies use of fluoroscopic or computed tomographic (CT) guidance, so your coding is inaccurate if the surgeon didn’t use image guidance.

In the CPT^® 2024 code booknotes for codes 64633 through +64636 (Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure)), it reads: “If fluoroscopic guidance is not used, report 64999.”