Paravertebral Facet Joint Nerve Destruction: Deleted, Replaced, Reduced Codes In 2012

CPT code series, from CPT 64622 to CPT 64627, is replaced with CPT code series 64633-64636

Since paravertebral facet joint nerve destructions emerge to see a small reimbursement increase in 2012 as compared to 2011, both physicians and ambulatory surgery centers may take a hit in reimbursement when carrying out these injections. Read this expert medical coding insight n how these CPT codes changes affect your reimbursement.

Effective Jan. 1, 2012, paravertebral facet joint nerve destructions will no longer be reported per nerve. As an alternative, four novel codes have been established to echo the work and anatomical site involved when carrying out these destructions. Remember before 2012, the injection was reported per nerve at a single vertebral level. CPT 2012 requires that the injection will be reported per facet joint. As per the AMA, It is vital to note the number of nerves injected for a single facet joint does not influence code selection

Out with the old (deleted):

CPT code series, from CPT 64622 to CPT 64627, is deleted in 2012.

In with the new (replaced):

CPT code series, from CPT 64622 to CPT 64627, is replaced with CPT code series 64633-64636:

64633 (Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint (new code in 2012))

+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) (new code in 2012))

64635 (Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint (new code in 2012))

+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) (new code in 2012))

It may not seem to be a reduction until we report the facet joint in spite of of the number of nerves destroyed. Let's compare:

In 2011: A patient goes through a radiofrequency nerve destruction of two medial branch nerves L3 and L4 innervating the symptomatic lumbar facet joint. Reimbursement contemplation is based upon the following listed CPT code selections:

64622 — ($495.72 (approximate 2012 ASC reimbursement))

64623 — ($294.00 (approximate 2012 ASC reimbursement))

In 2012: A patient goes through a radiofrequency nerve destruction of two medial branch nerves L3 and L4 innervating the symptomatic lumbar facet joint. Reimbursement consideration is based upon the following listed CPT code selection:

64635 — ($516.47 (approximate 2012 ASC reimbursement))

CPT 2012 Coding tips:

Image guidance and localization are essential for the performance of paravertebral facet joint nerve destruction by means of neurolytic agent explained by CPT codes 64633 -64636.

You must not report 64633-64636 in combination with 77003 or 77012). Both CPT 77003 and/or 77012 are considered inclusive to the injection procedure in 2012. In case CT or fluoroscopic imaging is not used/documented, report unlisted CPT code 64999.

In case both facet joints at the same vertebral level are treated, then CPT 64633 or 64635 should be reported with modifier -50 appended pending carrier reporting necessities for bilateral procedures (-50 versus RT/LT versus units).