FIRST COAST SERVICE OPTIONS
LOCAL COVERAGE DETERMINATION
CODING GUIDELINES
Contractor’s
Determination Number
64633
LCD Database ID Number
L29132 – Florida
L29150 – Puerto
Rico/Virgin Islands
Contractor Name
First
Coast Service Options, Inc.
Contractor
Number
09102 –
09202 – Puerto Rico
09302 –
LCD Title
Destruction of Paravertebral Facet Joint Nerve(s)
Coding
Guidelines
Image guidance
(fluoroscopy or CT) and the injection of an additional substance (e.g.,
anesthetic, contrast material) are considered inclusive components of
procedure codes 64633-64636, and are not separately reimbursable. Therefore, it would not be appropriate to
bill procedure codes 64490-64495 (injection procedure codes for facet joint or
facet joint nerve) in addition to procedure codes 64633-64636.
If more than one
level of neurolytic nerve destruction is performed,
use procedure code 64636 (Lumbar or sacral, each additional facet joint) with 64635 (lumbar or
sacral, single facet joint) or use procedure code 64634 (cervical or thoracic,
each additional facet joint) with 64633 (cervical or thoracic, single facet
joint).
Procedure codes 64633-64636
are unilateral procedure codes. For
bilateral procedures, use modifier “50”.
Comments
N/A
Revision History
|
Date |
Revision |
|
01/01/2012 |
3 – Annual 2012 HCPCS
Update. CPT codes 64622 – 64627 were
deleted and replaced with CPT codes 64633 – 64636. Contractor’s Determination Number 64622 was
changed to 64633. The effective date
of this revision is based on date of service. |
|
01/01/2010 |
2 – Annual 2010
HCPCS Update. Deleted CPT codes
64470-64476. Added CPT codes
64490-64495. The effective date of
this revision is based on date of service. |
|
09/30/2009 |
1 – Coding
Guidelines have been revised as some of the information was outdated. The effective date of this revision is
based on date of service. |
|
02/02/2009 – |
Original |
Document formatted: 11/14/2011(DE/st)