Anesthesia Coding Alert

Correct coding for radiofrequency thermoneurolysis depends on ensuring that the nerve was treated but not permanently destroyed, knowing what nerve was treated, and not letting the CPT index trip you up when searching for appropriate codes. Anesthesia providers use radiofrequency neurolysis also known as rhizotomy, RF denervation, radiofrequency thermoneurolysis and other names to temporarily destroy nerves to relieve pain. Verify That the Nerve Was Treated But Not Destroyed If the doctor continuously applies high-frequency energy to a patient's nerve tissue, the nerve heats up to more than 65 degrees Celsius, which is enough to destroy conduction through that nerve (known as thermocoagulation radiofrequency). If the physician delivers the energy as intermittent pulses (known as pulsed radiofrequency), signal conduction along the nerve is still interrupted for three to 18 months even though the tissue barely heats. This technique appears to produce longer-lasting pain relief than chemical nerve blocks, without the risk of the chemical spreading to areas not targeted for treatment. Physicians often use pulsed RF to treat peripheral nerves without a myelin sheath, such as those to facet joints (nonmyelinated nerves respond better to this type of treatment). Sympathetic nerves also respond well to RF treatments.

Every patient who undergoes RF neurolysis may not experience total pain relief, and pain may recur or even worsen (known as anesthesia dolorosa). Because of this, physicians often use RF neurolysis as a last resort for treating chronic pain that has not responded well to other therapies. These conditions include intractable back pain (724.x, Other and unspecified disorders of back), facial pain (350.2, Trigeminal nerve disorders; atypical face pain; or 351.8, Facial nerve disorders; other facial nerve disorders), headache (784.0, Symptoms involving head and neck; headache), chest wall pain (786.52, Chest pain; painful respiration), or neck (723.1, Other disorders of cervical region; cervicalgia), arm (729.5, Other disorders of soft tissues; pain in limb) and shoulder (719.41, Other and unspecified disorders of joint; pain in joint; shoulder region) pain. For coding, you need to ensure that the doctor treated the nerve and relieved the patient's pain, but that he or she did not destroy the nerve. "Using the pulse technique is a lot like dimming a lightbulb instead of switching it off completely," says Robin Fuqua, CPIC, a coder with Jose Feliz, MD, Inc. in Escondido, Calif. "It's a lot healthier for the patient than completely destroying the nerve." Code All Parts of the Procedure Some physicians precede RF procedures with a diagnostic block to ensure that the patient has at least 50 percent pain reduction once the physician injects a local anesthetic to the area. The practitioner normally performs the diagnostic block and therapeutic RF procedure at two separate sessions [...]