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The procedure described by CPT® Code 64610 involves the destruction of the trigeminal nerve's second and third division branches at the foramen ovale using a neurolytic agent, specifically under radiologic monitoring. This intervention is primarily aimed at alleviating chronic pain, particularly in patients suffering from conditions such as trigeminal neuralgia. 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 needle is connected to a generator that facilitates motor and sensory testing, ensuring accurate positioning at the nerve responsible for the patient's pain. Once the correct nerve pathway 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 hypertonic or hypotonic solutions. Alternatively, thermal or electrical modalities may be used, where a probe or needle 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 accurately, and the radiofrequency device 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, different CPT codes are applicable, specifically CPT® Code 64600. Additionally, for the second or third division branches of the trigeminal nerve at the foramen ovale, CPT® Code 64605 is used when the procedure is performed without radiologic monitoring, while CPT® Code 64610 is designated for procedures conducted with radiologic oversight.
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The procedure described by CPT® Code 64610 is indicated for patients experiencing chronic pain associated with conditions affecting the trigeminal nerve, particularly trigeminal neuralgia. This condition is characterized by severe, episodic facial pain that can be debilitating. The destruction of the second and third division branches of the trigeminal nerve at the foramen ovale is performed to provide relief from this pain when conservative treatments have failed or are not suitable for the patient.
The procedure for CPT® Code 64610 involves several critical steps to ensure effective destruction of the targeted nerve branches. Initially, the physician prepares the patient and the necessary equipment, including the electrode needle and the radiofrequency device. The first step is the introduction of the electrode needle through the skin, which is then carefully advanced toward the targeted neural tissue at the foramen ovale. This precise positioning is crucial for the success of the procedure. Once the needle is in place, it is connected to a generator that facilitates motor and sensory testing. This testing is performed to confirm that the needle is correctly positioned at the nerve responsible for the patient's pain. After confirming the correct placement, the physician can proceed with the destruction of the nerve. If a chemical neurolytic agent is chosen for the procedure, it is injected along the nerve pathway to achieve the desired neurolytic effect. Alternatively, if thermal or electrical modalities are utilized, the probe or needle is activated to generate heat, effectively destroying the nerve tissue. In the case of radiofrequency nerve destruction, the electrode needle is adjusted as necessary to ensure optimal positioning. The radiofrequency device is then activated, generating an electric current that produces heat at the tip of the electrode, leading to the destruction of the targeted nerve tissue. This step is critical as it ensures that the nerve is adequately treated to alleviate the patient's chronic pain.
After the procedure, patients may experience some discomfort or pain at the site of the injection or electrode placement. It is essential for healthcare providers to monitor the patient for any immediate adverse reactions. Patients are typically advised to rest and may be given specific instructions regarding pain management, which could include the use of analgesics. Follow-up appointments may be scheduled to assess the effectiveness of the procedure in alleviating pain and to monitor for any potential complications. Additionally, patients should be informed about the signs of infection or other complications that may require immediate medical attention. Overall, the expected recovery period can vary, but many patients report significant pain relief following the procedure.
| Short Descr | INJECTION TREATMENT OF NERVE | Medium Descr | DSTRJ NEURLYTIC TRIGEM NRV 2/3 DIV RADIO MONITOR | Long Descr | Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale under radiologic monitoring | 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) | 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 | 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.
| 77003 | CPT Add On MPFS Status: Active Code APC N ASC N1 Physician Quality Reporting CPT Assistant Article Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (List separately in addition to code for primary procedure) |
| LT | Left side (used to identify procedures performed on the left side of the body) | 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). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient 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). | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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). | 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 | GW | Service not related to the hospice patient's terminal condition | RT | Right side (used to identify procedures performed on the right side of the body) | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
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| Pre-1990 | Added | Code added. |