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The procedure described by CPT® Code 64681 involves the destruction of the superior hypogastric plexus, a critical nerve structure located in the retroperitoneal space between the L5 and S1 vertebrae. This plexus plays a significant role in transmitting pain signals from the pelvic region. The destruction of this nerve plexus is primarily indicated for the management of pain associated with metastatic cancer in the pelvic area, as well as for nonmalignant chronic pain conditions. The procedure can be performed using various techniques, including the injection of a neurolytic agent or through thermal, electrical, or radiofrequency methods. The use of radiologic monitoring during the procedure is optional, which aids in ensuring accurate needle placement. When radiologic guidance is employed, a needle is inserted at the L5-S1 interspace, and contrast material is injected to verify the correct positioning of the needle in the prevertebral space. The neurolytic agents used for chemical destruction may include substances such as phenol, ethyl alcohol, glycerol, ammonium salt compounds, and hypertonic or hypotonic solutions. Alternatively, thermal or electrical destruction techniques involve the insertion of a probe or needle that generates heat to ablate the nerve tissue. In the case of radiofrequency nerve destruction, an electrode needle is carefully positioned to deliver an electric current that produces heat at the electrode tip, effectively destroying the targeted nerve tissue. This procedure aims to alleviate pain by interrupting the nerve pathways responsible for transmitting pain signals from the pelvic region.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 64681 is indicated for the following conditions:
The procedure for the destruction of the superior hypogastric plexus involves several key steps, which may vary depending on the technique used.
After the procedure, patients may be monitored for any immediate complications or side effects. Post-procedure care typically includes pain management and instructions for activity restrictions to promote healing. Patients may experience some discomfort at the injection site, which is generally manageable with prescribed analgesics. 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 patients to report any unusual symptoms or complications to their healthcare provider promptly.
| Short Descr | INJECTION TREATMENT OF NERVE | Medium Descr | DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS | Long Descr | Destruction by neurolytic agent, with or without radiologic monitoring; superior hypogastric plexus | 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) | 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) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 8 - Other non-OR or closed 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). | 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. | 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.) | 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 | 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 |
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| 2004-01-01 | Added | First appearance in code book in 2004. |
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