Description of CPT code 64630, 64632 & 64640
This procedure (CPT code 64630) is performed to treat chronic pain of the external genitalia, pelvis, and anorectal region. The pudendal nerve is destroyed using chemical, thermal, electrical, or radiofrequency techniques, which may be used independently or in combination. This procedure is designed to destroy the specific site(s) in the nerve root that produces the pain while leaving sensation intact. Generally intravenous conscious sedation is used during the initial phase of the procedure so that the patient can assist the physician in identifying the site of pain and the correct placement of the neurolytic agent, and local anesthesia is administered during the destruction phase of the procedure. Using separately reportable fluoroscopic or CT guidance, a needle is inserted next to the ischial spine, contrast dye is injected, and the nerve canal anatomy is confirmed.
An electrode is inserted through the needle and a mild electrical current is passed through the electrode. The current produces a tingling sensation at a site on the nerve. The electrode is manipulated until the tingling sensation is felt at the same site as the pain. Once the physician has determined that the electrode is positioned at the site responsible for the pain, a local anesthetic is administered and a neurolytic agent applied. Chemical destruction involves injection of a neurolytic substance (e.g., alcohol, phenol, glycerol) into the affected nerve root. Thermal techniques use heat. Electrical techniques use an electrical current. Radiofrequency, also referred to as radiofrequency rhizotomy, uses a solar or microwave current.
CPT code 64632 is reported when the procedure is performed on plantar nerve and this treatment is for Morton’s neuroma.
CPT code 64640 is reported to treat chronic pain that originates in a peripheral nerve other than the intercostal, pudendal, plantar, or spinal nerves. The affected peripheral nerve is destroyed using chemical, thermal, electrical, or radiofrequency techniques, which may be used independently or in combination.
64630 Destruction by neurolytic agent; pudendal nerve
64632 ; plantar common digital nerve
64640 ; other peripheral nerve or branch
Question: Is it appropriate to report code 64640 in conjunction with code 76942?
Answer: Yes, it is appropriate to report code 64640, Destruction by neurolytic agent; other peripheral nerve or branch, with code 76942, Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation, because imaging is not inherent to the procedure described or included in code 64640.