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The procedure described by CPT® Code 64600 involves the destruction of specific branches of the trigeminal nerve, namely the supraorbital, infraorbital, mental, or inferior alveolar branches. This intervention is primarily aimed at alleviating chronic pain conditions associated with these nerve pathways. The destruction can be achieved through various techniques, including the injection of a neurolytic agent or the application of thermal, electrical, or radiofrequency methods. Among these, radiofrequency destruction is the most commonly utilized technique in contemporary practice due to its effectiveness in targeting nerve tissue. Prior to the actual destruction, a precise approach is taken where an electrode needle is inserted through the skin and directed towards the affected neural tissue. This needle is connected to a generator that facilitates motor and sensory testing, ensuring accurate placement at the nerve responsible for the patient's pain. Once the correct nerve is identified, the destruction process is initiated. If a chemical neurolytic agent is employed, it is injected along the nerve pathway to achieve the desired effect. Common neurolytic agents include phenol, ethyl alcohol, glycerol, ammonium salt compounds, and various hypertonic or hypotonic solutions. Alternatively, thermal or electrical modalities utilize a probe or needle that, once inserted, generates heat to destroy the nerve tissue. In the case of radiofrequency nerve destruction, the electrode needle is carefully positioned, and upon activation of the radiofrequency device, an electric current is produced that generates heat at the electrode's tip, effectively destroying the targeted nerve tissue. This procedure is specifically coded as 64600 for the destruction of the aforementioned branches of the trigeminal nerve.
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The procedure coded as CPT® 64600 is indicated for the treatment of chronic pain conditions associated with the branches of the trigeminal nerve. The specific indications for this procedure include:
The procedure for CPT® 64600 involves several critical steps to ensure effective destruction of the targeted nerve branches. The steps are as follows:
After the procedure coded as CPT® 64600, patients may experience some immediate effects, including localized pain relief. Post-procedure care typically involves monitoring for any adverse reactions or complications. Patients are often advised to rest and may be prescribed analgesics to manage any discomfort. Follow-up appointments may be scheduled to assess the effectiveness of the procedure and to determine if additional treatments are necessary. It is important for healthcare providers to educate patients about potential side effects and the expected timeline for pain relief following the procedure.
| Short Descr | INJECTION TREATMENT OF NERVE | Medium Descr | DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH | Long Descr | Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch | Status Code | Active Code | Global Days | 010 - Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 2 - 150% payment adjustment does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory 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 | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 2 | CCS Clinical Classification | 9 - Other OR therapeutic nervous system procedures |
This is a primary code that can be used with these additional add-on codes.
| 77002 | CPT Add On MPFS Status: Active Code APC N ASC N1 Physician Quality Reporting CPT Assistant Article Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure) |
| 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. | 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) | 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). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | CR | Catastrophe/disaster related | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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