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The pudendal nerve plays a crucial role in controlling sensation in the perineal area, which includes the region between the genitals and the anus, the rectum, and the external genitalia. The procedure described by CPT® Code 64630 involves the destruction of the pudendal nerve, primarily aimed at alleviating chronic pain conditions associated with this nerve. This destruction can be achieved through various methods, including the injection of a neurolytic agent or the application of thermal, electrical, or radiofrequency techniques. Among these methods, radiofrequency destruction has emerged as the most commonly utilized technique in contemporary practice, although other approaches may be employed depending on the specific pain syndrome being treated. The procedure typically begins with the introduction of an electrode needle through the skin, which is then carefully advanced toward the targeted neural tissue. This step is critical as it allows for precise 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, either by injecting a neurolytic chemical agent along the nerve pathway or by utilizing thermal or electrical modalities to generate heat and destroy the nerve tissue. Neurolytic agents that may be used include phenol, ethyl alcohol, glycerol, ammonium salt compounds, and hypertonic or hypotonic solutions. The choice of technique and agent depends on the clinical scenario and the specific characteristics of the pain being treated.
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The destruction of the pudendal nerve is indicated for patients experiencing chronic pain conditions that are associated with the pudendal nerve. This may include, but is not limited to, the following:
The procedure for the destruction of the pudendal nerve involves several critical steps to ensure accuracy and effectiveness. First, an electrode needle is introduced through the skin and carefully advanced toward the targeted neural tissue. This initial step is essential for proper placement and is followed by motor and sensory testing to confirm that the needle is correctly positioned at the pudendal nerve. Once the correct nerve pathway is identified through these tests, the next step involves the actual destruction of the nerve. If a neurolytic chemical agent is chosen for the procedure, it is injected along the nerve pathway to achieve the desired effect. Alternatively, if thermal or electrical modalities are utilized, a probe or needle is inserted through the skin and activated to produce heat, effectively destroying the nerve tissue. In the case of radiofrequency nerve destruction, the electrode needle is again introduced through the skin and advanced toward the targeted neural tissue. The electrode is adjusted as necessary to ensure correct positioning, after which the radiofrequency device is activated. This device generates an electric current that produces heat at the tip of the electrode, leading to the destruction of the targeted nerve tissue.
After the procedure, patients may experience some discomfort at the injection site or in the treated area, which is typically managed with standard post-procedure care. It is important for patients to follow any specific instructions provided by their healthcare provider regarding activity restrictions, pain management, and follow-up appointments. Recovery time may vary depending on the individual and the extent of the procedure performed. Patients should be monitored for any potential complications, and ongoing assessment of pain relief and functional improvement is essential to evaluate the success of the procedure.
| Short Descr | INJECTION TREATMENT OF NERVE | Medium Descr | DSTRJ NEUROLYTIC AGENT PUDENDAL NERVE | Long Descr | Destruction by neurolytic agent; pudendal nerve | 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) | 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 | 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 | 1 | CCS Clinical Classification | 9 - Other OR therapeutic nervous system procedures |
| 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. | 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. | 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. | 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.) | 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 | KX | Requirements specified in the medical policy have been met | 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) | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2001-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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