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The procedure described by CPT® Code 64605 involves the destruction of the second and third division branches of the trigeminal nerve at the foramen ovale using a neurolytic agent. This intervention is primarily aimed at alleviating chronic pain, particularly in patients who have not responded to other pain management strategies. The destruction of nerve tissue can be achieved through various techniques, including the injection of a chemical neurolytic agent or the application of thermal, electrical, or radiofrequency methods. Among these, radiofrequency destruction is the most commonly utilized technique in contemporary practice. The procedure begins with the introduction of an electrode needle through the skin, which is then carefully advanced toward the targeted neural tissue. This step is crucial as it allows for motor and sensory testing to confirm the accurate positioning of the needle at the nerve responsible for the patient's pain. Once the correct nerve pathway is identified, the destruction of the nerve is performed. 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 hypertonic or hypotonic solutions. Alternatively, thermal or electrical modalities involve the use of a probe or needle that is inserted through the skin and activated to generate heat, effectively destroying the nerve tissue. In the case of radiofrequency nerve destruction, the electrode needle is positioned similarly, and once correctly placed, an electric current is activated to produce heat at the electrode's tip, leading to the destruction of the targeted nerve tissue. It is important to note that for procedures involving the destruction of other branches of the trigeminal nerve, such as the supraorbital, infraorbital, mental, or inferior alveolar branches, CPT® Code 64600 should be used. Additionally, when the destruction of the second or third division branches at the foramen ovale is performed without radiologic monitoring, CPT® Code 64605 is appropriate; however, if radiologic monitoring is utilized during the procedure, CPT® Code 64610 should be applied.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 64605 is indicated for patients experiencing chronic pain that is associated with the second and third division branches of the trigeminal nerve. This chronic pain may arise from various conditions, including but not limited to:
The procedure for CPT® Code 64605 involves several critical steps to ensure effective destruction of the targeted nerve branches. The following procedural steps are outlined:
After the procedure, patients may experience some discomfort or swelling at the injection site, which is typically managed with standard post-procedure care. Patients are usually monitored for any immediate adverse effects and may be advised to rest for a short period. Follow-up appointments may be scheduled to assess the effectiveness of the procedure and to monitor for any potential complications. It is important for patients to report any unusual symptoms or prolonged pain following the procedure, as these may require further evaluation. The expected recovery time can vary based on individual patient factors and the extent of the procedure performed.
| Short Descr | INJECTION TREATMENT OF NERVE | Medium Descr | DSTRJ NEUROLYTIC TRIGEMINAL NRV 2/3 DIV BRANCH | Long Descr | Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale | 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) | 1 - 150% payment adjustment for bilateral procedures applies. | 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 | 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 | 1 | 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) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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). | 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. | 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. | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | 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 | 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) |
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| Pre-1990 | Added | Code added. |