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Paravertebral Facet Joint Destruction Coding

Proper paravertebral facet joint destruction coding is not based on per facet joint nerve, it is based upon the destruction of the sensory innervation for each facet joint.

The number of nerves treated does not affect the CPT code selection even though two nerves innervate each facet joint. This is reflected in the term “nerve(s)” which are included in the code descriptors. Therefore, only one unit of service may be reported for each joint regardless of the number of nerves treated. To clarify, the typical patient has two nerves treated for each facet joint. These nerves are at two different vertebral level, the code is reported once per joint treated no matter how many nerves are treated.

Relevant codes include:

  • 64633 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint
  • +64634 … each additional facet joint (List separately in addition to code for primary procedure)
  • 64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint
  • +64636 each additional facet joint (List separately in addition to code for primary procedure)

Image guidance (Fluoroscopy or CT) is required and is not billable separately with either 77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) or 77012 Computed tomography guidance for needle placement (Eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation. Facet joint nerve destruction is a unilateral procedure and you may append modifier 50 Bilateral procedure for bilateral facet joint nerve destruction.