november 2017

Destruction by Neurolytic Agent Guidelines

At the beginning of the section for Destruction by Neurolytic Agent there are instructions for the use of these codes which state:

“Do not report a code labeled as destruction when using therapies that are not destructive of the target nerve (eg, pulsed radiofrequency), use 64999.

Now look at the instruction listed before the facet joint destruction CPT codes.

“Do not report 64633, 64634, 64635, 64636 for non-thermal facet joint denervation including chemical, low grade thermal energy (<80 degrees Celsius), or any form of pulsed radiofrequency. To appropriately report any of these modalities, use 64999”.  You will notice that the facet joint instructions are more descriptive for the types of services that should be reported with the unlisted code 64999.

I get this question a lot and that is – if radiofrequency destruction is performed on a nerve that is not a facet joint/nerve and it is less than 80 degrees Celsius, would you still report the unlisted CPT code?

I would recommend that the unlisted code 64999 still be reported for the example listed above because the section guidelines state that when a therapy is not destructive of the target nerve report 64999Even though the only example they give is for pulsed radiofrequency – low grade thermal energy (<80 degrees Celsius) would not destroy the nerve therefore you should not report a nerve destruction procedure.




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