2025 CPT code 64681
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Nervous System Surgery Feed
Destruction by neurolytic agent, with or without radiologic monitoring; superior hypogastric plexus.
Modifiers may be applicable. Modifier 22 might be used to indicate increased procedural services, while modifier 59 is occasionally required to indicate the distinct nature of a procedure performed in conjunction with another, potentially overlapping service.
Medical necessity must be established by documenting the patient's chronic pelvic pain, failed conservative treatments, and the underlying condition causing the pain.
The physician is responsible for preparing and anesthetizing the patient, using imaging guidance (if necessary) to insert the needle, confirming proper needle placement, injecting the neurolytic agent, and managing any potential complications.
In simple words: The doctor injects medicine into a nerve bundle in your lower back to destroy part of it and lessen pelvic pain. This is often done for conditions like cancer or endometriosis. The doctor might use imaging like X-rays or CT scans to guide the injection.
This code represents the destruction of the superior hypogastric plexus using a neurolytic agent, which can be chemical, thermal, or electrical. This procedure aims to reduce pelvic pain and is often used for conditions like malignancy or endometriosis. The procedure may involve radiologic monitoring for guidance.
Example 1: A patient with intractable pelvic pain due to advanced prostate cancer undergoes destruction of the superior hypogastric plexus using a chemical neurolytic agent under fluoroscopic guidance., A patient with severe endometriosis experiences chronic pelvic pain unresponsive to other treatments. Destruction of the superior hypogastric plexus is performed using radiofrequency ablation., A patient with pelvic pain from a non-malignant cause undergoes injection of a neurolytic agent into the superior hypogastric plexus without radiologic monitoring.
Documentation should include details about the patient's pain, prior treatments, the type of neurolytic agent used, the method of administration (with or without imaging guidance), and any complications encountered.
- Specialties:Pain Management, Anesthesiology, Radiology, Oncology, Gynecology, Urology
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient Department, Physician's Office