Radiology Coding Alert

Question: When billing lumbar/cervical non-pulsed radiofrequency facet denervation codes 64622/64623 (lumbar) and 64626/64627 (cervical), how should we count the services?

Codify Member

Answer: For 2011 dates of service, you should report these codes per nerve level. As explained below, the codes have been replaced in 2012.

Regarding the 2011 codes, CPT® Assistant (September 2004) explains it this way: "facet nerve destruction codes 64622-64627 [Destruction by neurolytic agent, paravertebral facet joint nerve ...] refer to individual nerve level destruction. Thus... destruction of the L3 and L4 medial branch nerves would be coded as 64622 and 64623."

For fluoroscopic guidance for 2011 procedures, 2011 code 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, subarachnoid, or sacroiliac joint], including neurolytic agent destruction) applies.

Important: The above information does not apply to 2012 dates of service. CPT® 2012 deletes 64622-+64627 and replaces those codes with guidance-inclusive codes:

• 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, ... lumbar or sacral, single facet joint
• +64636, ... lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure).

Because 64633-+64636 include guidance, you should not report 77003 in conjunction with those codes.

Bonus tip: Code 77003 has been revised for 2012, too. The revised code descriptor is "Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid)."