Are you a pain management provider struggling with a higher denial rate on your neurolysis claims? Do not worry! This guide is all about decoding CPT code 64640.
From clinical scenarios to applicable modifiers and reimbursement guidelines, we will discuss everything. The outcome? Once you are done reading this guide, you will be able to submit claims that check all the boxes for first-pass rate, leading to a healthier revenue realization.
So, continue reading!
CPT Code 64640 – Description
CPT code 64640 covers neurolysis of peripheral nerves or branches. It includes the destruction of nerves that carry pain information. The physician may utilize radiofrequency, heat, or chemical techniques to achieve desired results.
It has a 10-day global period.
Scenarios Where CPT Code 64640 is Applicable
Let’s review a few real-world clinical scenarios where neurolysis of a peripheral nerve or branch applies:
Ilioinguinal Neuralgia (Post-Surgical Pain)
Picture a 50-year-old male patient who underwent a robotic inguinal hernia repair six months ago. He complains about experiencing persistent, searing pain in the groin and medial thigh. Besides, pain is exacerbated by hip extension.
The physician performs a diagnostic nerve block using a temporary local anesthetic to identify the source of the pain. It confirms that the ilioinguinal nerve is the primary pain generator.
As a result, under ultrasound guidance, the physician performs chemical neurolysis of the ilioinguinal nerve using a phenol solution. It focuses on providing long-term pain interruption.
Here, CPT code 64640 will be reported to bill for the neurolysis.
Chronic Occipital Neuralgia
Assume a 45-year-old female patient who suffers from chronic, piercing headaches radiating from the base of the skull to the top of the head. The patient also has a history of cervical whiplash. Previously, the physician prescribed oral muscle relaxants and migraine protocols. However, they failed to manage the condition.
Thus, the physician performs neurolysis (CPT code 64640) using cryoneurolysis on the greater occipital nerve to ablate the nerve fibers responsible for the chronic pain signals. For context, cryoneurolysis utilizes extreme cold to achieve temporary nerve destruction.
Genitofemoral Nerve Ablation
Imagine a 40-year-old male patient with chronic neuropathic pain in the pelvic and inguinal region following an appendectomy. Diagnostic blocks have pinpointed the genital branch of the genitofemoral nerve.
Therefore, the physician utilizes radiofrequency ablation (thermal energy) to perform neurolysis on a separate day. It destroys the nerve’s ability to transmit pain signals.
Here, CPT code 64640 applies.
Applicable Modifiers for CPT Code 64640
Discussed below are some of the applicable modifiers for CPT 64640:
Modifier 50
What happens when the physician performs neurolysis on the same nerve or branch on both the right and left sides of the body during the same session?
You append modifier 50 to CPT code 64640 to indicate bilateral service. Additionally, it ensures you receive 150% of the allowed reimbursement.
Modifier 51
Did the physician render another distinct procedure during the same session as CPT code 64640? If this is the case, do not forget to append modifier 51. It is an integral modifier that ensures you are reimbursed at a 100% payment rate for the primary (higher value) service, and a 50% payment rate for the secondary service.
Modifier 59 or XS
You may encounter a scenario where you perform the service covered under CPT code 64640 more than once, but on a separate structure. When this happens, report the second CPT with modifier 59 or XS, based on the payer preference.
Modifiers LT & RT
These are anatomical modifiers that help you explain to the payer on which side of the body you performed the neurolysis. But, be wary as you cannot report it with modifier 50.
CPT Code 64640 – Billing & Reimbursement Guidelines
The following are the essential billing guidelines for CPT 64640:
Fulfill Documentation Requirements
Comprehensive documentation is a key requirement established by most payers, including Medicare. Besides, it helps justify the medical necessity of neurolysis. Thus, when billing for CPT code 64640, include the following:
- Explicitly mention that the patient failed conservative treatment, such as activity modification, physical therapy, etc.
- Explain the diagnostic nerve blocks performed by the physician and their success rate.
- Mention the name(s) of the exact nerve(s) that you treated.
- Clearly state the destruction method utilized, such as thermal, chemical, radiofrequency ablation, or cryoneurolysis.
- Describe whether the physician performed the procedure on the right side, left side, or bilaterally.
Do NOT Bill CPT Code 64640 More Than 5 Times
You must understand the frequency limitation of CPT 64640 to avoid unexpected denials. As per Medicare reimbursement guidelines, you are only allowed to report five units of this procedural code on a single date of service.
Append Appropriate Modifier
Modifiers offer coding specificity. However, their misuse or overuse can result in audits and heavy penalties. Thus, your documentation must support the use of a modifier. Some of the modifiers that apply to CPT 64640 include 50, 51, LT, RT, 59, or XS.
You can learn more about their appropriate use in the ‘Applicable Modifiers for CPT Code 64640’ section.
Summary
With that said, let’s conclude this guide. Here’s a quick recap!
CPT code 64640 covers neurolysis of a peripheral nerve or branch using either chemical, heat, or radiofrequency techniques.
You must use anatomical modifiers (LT, RT) to specify on which side of the body you performed the destruction of the nerve. In case you perform it bilaterally, append modifier 50. Some other modifiers that apply to it include 51, 59, and XS.
Hopefully, with these guidelines, billing for neuralysis will become a breeze for you. However, if you still struggle, feel free to outsource pain management billing services to professionals, like MediBillMD.
