© Copyright 2025 American Medical Association. All rights reserved.
Thermal destruction of the intraosseous basivertebral nerve is a specialized procedure aimed at alleviating chronic low back pain. This technique specifically targets the basivertebral nerves, which are sensory nerves located within the center of the vertebral body and at the vertebral end plates. These nerves exit the vertebral body through the basivertebral foramen, and their activation is often associated with "vertebrogenic" pain, a type of pain believed to arise from degeneration of the intervertebral disc and the vertebral endplates. The procedure is performed using a transpedicular approach, which involves accessing the vertebral body through a small incision. Under fluoroscopic guidance, a trocar is inserted to facilitate access to the vertebral body. A curved cannula assembly is then utilized to create a tunnel through the vertebral body, allowing for precise targeting of the basivertebral nerve. To enhance the channel to the nerve, a straight channeling stylet may be employed if necessary. The final step involves the use of a bipolar radiofrequency probe connected to a generator, which applies thermal energy to the basivertebral nerve, effectively destroying it and interrupting the transmission of pain signals. This procedure is particularly relevant for patients suffering from chronic low back pain that has not responded to conservative treatments. The CPT® code 64629 is specifically designated for reporting the thermal destruction of each additional lumbar or sacral vertebral body beyond the first two, which are reported using CPT® code 64628.
© Copyright 2025 Coding Ahead. All rights reserved.
Thermal destruction of the intraosseous basivertebral nerve is indicated for patients experiencing chronic low back pain that is believed to be generated by the basivertebral nerves. This procedure is particularly relevant for individuals who have not found relief through conservative treatment options, such as physical therapy, medication, or other non-invasive interventions. The procedure targets pain that is associated with degeneration of the intervertebral disc and the vertebral endplates, which can lead to significant discomfort and impairment in daily activities.
The procedure for thermal destruction of the intraosseous basivertebral nerve involves several key steps to ensure effective treatment. Initially, the patient is positioned appropriately to allow for optimal access to the lumbar or sacral vertebral bodies. Under fluoroscopic guidance, a small incision is made to facilitate the insertion of an introducer trocar. This trocar is carefully advanced through the incision and into the vertebral body using a transpedicular approach, which minimizes disruption to surrounding tissues. Once the trocar is in place, a curved cannula assembly is introduced through the trocar to create a tunnel that leads directly to the basivertebral nerve. If necessary, a straight channeling stylet may be utilized to extend the channel further to ensure precise access to the nerve. Following the establishment of the channel, a bipolar radiofrequency probe is connected to a generator. This probe is then inserted through the cannula and positioned at the basivertebral nerve. The generator is activated to deliver thermal energy, which heats the nerve and leads to its destruction. This process effectively interrupts the transmission of pain signals, providing relief from chronic low back pain.
After the thermal destruction of the intraosseous basivertebral nerve, patients may experience immediate relief from pain, although it is important to note that full effects may take time to manifest as the nerve heals. Post-procedure care typically includes monitoring for any immediate complications, such as infection or bleeding at the incision site. Patients are often advised to limit physical activity for a short period to allow for proper healing. Follow-up appointments may be scheduled to assess pain levels and overall recovery. It is essential for patients to communicate any concerns or unusual symptoms to their healthcare provider during the recovery phase.
| Short Descr | TRML DSTRJ IOS BVN EA ADDL | Medium Descr | THERMAL DSTRJ INTRAOSSEOUS BVN EA ADDL LMBR/SAC | Long Descr | Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; each additional vertebral body, lumbar or sacral (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | 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) | 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 | Items and Services Packaged into APC Rates | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | none | MUE | 2 |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 64628 | Resequenced Code MPFS Status: Active Code APC J1 ASC J8 Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral |
| XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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. | KX | Requirements specified in the medical policy have been met | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | SG | Ambulatory surgical center (asc) facility service | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main 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. | 74 | Discontinued out-patient hospital/ambulatory surgery center (asc) procedure after administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc). under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of modifier 74. note: the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. for physician reporting of a discontinued procedure, see modifier 53. | 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. | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | 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 | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | KK | Dmepos item subject to dmepos competitive bidding program number 2 | 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) | X2 | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2022-01-01 | Added | Code added |
Get instant expert-level medical coding assistance.