Basivertebral Nerve (BVN) Ablation

 

“Spotlight on CPT” this month will focus on the topic basivertebral nerve (BVN) ablation.  So, the first thing that we need to ascertain is where are basivertebral nerves located.  Basivertebral nerves are found in the vertebral bodies.  Once the nerve enters through the posterior part of the vertebral body, it branches to supply the endplates of the vertebral body.

Source:  https://operativeneurosurgery.com/doku.php?id=basivertebral_nerve

It has been demonstrated, that if degeneration or damage is done to the vertebral body endplates, the nerve fibers become denser which lends credence to them playing a significant role in chronic back pain.  To address the chronic low back pain when other conservative measures have failed (i.e., physical therapy, rest, steroid injections, etc.), an ablation procedure can be performed.

The ablation of the BVN is typically done in an outpatient setting under anesthesia.  With the patient, prone on the table, the provider makes an incision over the targeted area.  Pedicle approach to the vertebral body is done via a curved cannula with fluoroscopic guidance.  The cannula will create a tunnel to the main trunk of the basivertebral nerve.  Ablation is then achieved via the use of a radiofrequency probe.  The ablation of the BVN effectively stops the pain signals from being transmitted.  This procedure is also called an Intracept procedure and usually takes about 80 minutes to perform.

Source: https://paleyinstitute.org/wp-content/uploads/Intracept-Patient-Guide.pdf

 

In CPT, there are now two codes that address BVN ablation.

64628    Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; first 2
              vertebral bodies, lumbar or sacral

+64629  each additional vertebral body, lumbar or sacral (List separately in addition to code for
              primary procedure)

Coding professionals should take note that 64629 is an add-on code that must be assigned in addition to 64628.

 

Now, light has been shed on coding for BVN ablation.

 

 

 

 

About the Author 

Dianna Foley, RHIA, CHPS, CCS, CDIP  is OHIMA's Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.