CPT® Code 0440T

Official Description

Ablation, percutaneous, cryoablation, includes imaging guidance; upper extremity distal/peripheral nerve

Common Language Description

The procedure described by CPT® Code 0440T involves percutaneous cryoablation, a technique utilized to alleviate chronic nerve pain. This minimally invasive procedure is performed under imaging guidance, which ensures precise targeting of the affected nerve(s). During cryoablation, a specialized instrument known as a cryoprobe is employed. This cryoprobe consists of a hollow cannula with a smaller inner lumen, through which a cooling agent—such as helium, argon, or liquid nitrogen—is delivered to the targeted nerve. The primary goal of this procedure is to destroy the myelin sheath surrounding the nerve, effectively interrupting the transmission of pain signals to the brain. The process begins with the insertion of one or more cryoprobes through the skin, guided by imaging techniques to ensure accurate placement. The correct positioning of the probes may be verified through a nerve stimulation test, which confirms that the targeted nerve is appropriately accessed. Once the probes are in place, a pressurized coolant is applied, traveling down the inner lumen of the cryoprobe and forming an ice ball at the tip. This ice ball expands and freezes the surrounding tissue, leading to the desired therapeutic effect. After the procedure, the gas formed from the coolant is expelled back up the probe, and the cryoprobes are subsequently removed. CPT® Code 0440T specifically reports the percutaneous cryoablation of an upper extremity distal or peripheral nerve, including the necessary imaging guidance, distinguishing it from other related codes for lower extremity nerves and nerve plexuses.

1. Indications

The procedure described by CPT® Code 0440T is indicated for patients experiencing chronic nerve pain, particularly in the upper extremity. This may include conditions where traditional pain management strategies have been ineffective, and there is a need for a targeted approach to alleviate discomfort. The use of cryoablation is particularly beneficial for patients who may not be suitable candidates for more invasive surgical interventions or those seeking a minimally invasive option to manage their pain.

Chronic Nerve Pain Patients suffering from persistent pain due to nerve damage or irritation in the upper extremity.
Failed Conservative Treatments Individuals who have not found relief from standard pain management therapies.
Minimally Invasive Preference Patients who prefer a less invasive procedure compared to traditional surgical options.

2. Procedure

The percutaneous cryoablation procedure begins with the patient being positioned appropriately to allow access to the targeted upper extremity nerve. Imaging guidance, such as ultrasound or fluoroscopy, is utilized to visualize the nerve and ensure accurate placement of the cryoprobe. Once the imaging confirms the correct location, the skin is prepared and anesthetized to minimize discomfort during the procedure. Next, the cryoprobe, which consists of a hollow cannula with a smaller inner lumen, is carefully inserted through the skin and advanced to the targeted nerve. The placement of the probe may be verified through a nerve stimulation test, which helps confirm that the probe is correctly positioned to affect the nerve. After confirming the placement, a pressurized coolant is introduced into the cryoprobe. This coolant travels down the inner lumen and forms an ice ball at the tip of the probe, which expands and freezes the surrounding tissue, effectively destroying the myelin sheath of the nerve. The freezing process interrupts the transmission of pain signals from the nerve to the brain, providing relief from chronic pain. Once the desired freezing effect is achieved, the gas formed from the coolant is expelled back up the probe, and the cryoprobe is carefully removed from the patient's body. The entire procedure is typically completed in a short time frame, allowing for a quick recovery.

3. Post-Procedure

After the cryoablation procedure, patients are monitored for a brief period to ensure there are no immediate complications. Post-procedure care may include instructions on managing any discomfort, which can be expected as the nerve begins to heal. Patients are often advised to avoid strenuous activities for a short period to allow for proper recovery. Follow-up appointments may be scheduled to assess the effectiveness of the procedure and to monitor the patient's pain levels. It is important for patients to report any unusual symptoms or prolonged pain to their healthcare provider during the recovery phase.

Short Descr	ABLTJ PERC UXTR/PERPH NRV
Medium Descr	ABLTJ PERC CRYOABLTJ IMG GDN UXTR/PERPH NERVE
Long Descr	Ablation, percutaneous, cryoablation, includes imaging guidance; upper extremity distal/peripheral nerve
Status Code	Carriers Price the Code
Global Days	YYY - Carrier Determines Whether Global Concept Applies
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator	Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate.
Berenson-Eggers TOS (BETOS)	P5E - Ambulatory procedures - other
MUE	3

51	Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
GC	This service has been performed in part by a resident under the direction of a teaching physician
LT	Left side (used to identify procedures performed on the left side of the body)
RT	Right side (used to identify procedures performed on the right side of the body)
XS	Separate structure, a service that is distinct because it was performed on a separate organ/structure