11/15/2023 0 Comments Complete anatomy billing![]() (Exceptions to this rule are the C2-3 facet joint, which is innervated by the third occipital nerve and the L5-S1 facet joint, which is innervated by the L4 MB and the L5 dorsal ramus.)įacet joint injection techniques are used in the diagnosis and/or treatment of chronic neck and back pain. ![]() The medial branches (MB) of the dorsal rami of the segmental nerves innervate facet joints and the MB nerves from the two adjacent dorsal rami innervate each joint. Sacral injections, identified on the claim by the ICD-10 codes M43.27, M43.28, M53.2X7, M53.2X8, M53.3, M53.86, M53.87, M53.88, are not subject to the requirements of this LCD.įacet joints are paired diarthrodial articulations of the superior and inferior articular processes of adjacent vertebrae. This policy does not address sacral conditions or injections or neurotomies. “All other techniques of facet joint denervation for the treatment of chronic back pain are considered investigational including, but not limited to: Pulsed radiofrequency denervation Laser Cryodenervation and Chemical denervation.” “Therapeutic (as opposed to diagnostic) medial branch blocks are considered investigational.” “Policy Guidelines” updated. “Chemical denervation” added to the “When Not Covered” section. Specialty Matched Consultant Advisory Panel review. For further information on reimbursement guidelines, please see Administrative Policies on the Blue Cross Blue Shield of North Carolina web site at They are listed in the Category Search on the Medical Policy search page.Īpplicable codes: 64633, 64634, 64635, 64636 Facet Joint Denervation Inclusion of a code in this section does not guarantee that it will be reimbursed. This policy may apply to the following codes. īilling/Coding/Physician Documentation Information ![]() Fluoroscopic guidance and localization for needle placement, is not included in codes 64622 64627 effective. correction to Paravertebral Facet Joint Denervation number 3. Revision History Number/Explanation CPT 2012 code update deleted codes 64622, 64623, 6467, added new codes 64633, 64634, 64635, and 64636 removed codes 77003, 77012 and references to them. Fluoroscopic and CT guidance and localization for needle placement, is included in codes 64633- 64636. Use the appropriate CPT code in Item 24D on the CMS-1500 form (or electronic equivalent) and link it to the applicable ICD-9-CM code in Item 24E (or electronic equivalent).ģ. If denervation is performed bilaterally, Modifier 50 should be appended to the procedure code with number of services of one.Ģ. If the denervation is performed at more than one level, unilateral or bilateral, CPT codes 6466 should be used for each of the subsequent levels. If a provider denervates only one level, unilateral or bilateral, CPT codes 64633 or 64635 should be used. (For bilateral procedure, report 64635 with modifier 50)Ħ4636 New code Lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure)ġ. CPT NEW DESCRIPTION 64633 DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT) CERVICAL OR THORACIC, SINGLE FACET JOINT 64634 DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT) CERVICAL OR THORACIC, EACH ADDITIONAL FACET JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)Ħ4635 New code Destruction by neurolytic agent paravertebral facet joint nerve(s) (fluoroscopy or CT Lumbar or sacral, single facet joint
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