Coding Q&A

Q: What is the appropriate way to report cryoneurolysis for the control of pain related to truncal or peripheral nerve pathologies?

Code family 64600-64681 describes its procedures as destruction of specified nerves by “chemical, thermal, electrical or radiofrequency.” Despite this, the American Medical Association (AMA) created the 0440T-0442T category 3 codes in 2015 to describe the use of a thermal technology (i.e., cryoablation) to perform denervation within the upper extremity (0440T), lower extremity (0441T) or trunk (0442T).

A: The 0440T-0442T codes were created specifically to describe cryoablation of nerves, (ablation, percutaneous, cryoablation, includes imaging guidance). The 64600-64681 family of codes do not adequately capture the physician work required to accomplish cryoneurolysis of peripheral or truncal nerves. Therefore, the AMA CPT panel agreed to the creation of these separate category 3 codes to report the image-guided targeting and cryoneurolysis of deep nervous structures described. These procedures typically require CT guidance given the anatomical deep location of the nerves. It is believed there is increasing adoption of image-guided cryoneurolysis since 2015.

The goal of a category 3 code is to collect utilization data and improve the literature base around the procedure with the goal of converting to Category 1 status. However, the continued inappropriate coding of percutaneous cryoneurolysis with the 646XX family codes has made it difficult to support this conversion as utilization of 0440T-0442T is perceived to be low. It is required to report 0440T-0442T when performing image-guided cryoneurolysis of the peripheral or truncal nerves. 0440T is used when treating upper extremity nerves, 0441T when treating lower extremity nerves, and 0442T when treating truncal nerves (including the brachial plexus).

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