Anesthesia Coding Alert

Hint: Unlisted might be your best bet

Reporting radiofrequency (RF) of the dorsal root ganglion can be tricky because CPT doesn't include a code specifically for it. If carriers are denying your destruction claims, you should evaluate whether you-re submitting the best-fitting code.
 
Some of the most common possibilities coders consider include:

- 64622-64627--Locations and levels for Destruction by neurolytic agent, paravertebral facet joint nerve

- 64640--Destruction by neurolytic agent; other peripheral nerve or branch

- 64999--Unlisted procedure, nervous system. Before you jump at one of these coding options, study the pros and cons of each to determine which really is the most accurate. Knowing Anatomy Eliminates Facet Codes If you-re tempted to report paravertebral facet joint nerve codes 64622-64627 for RF of the dorsal root ganglion, take a closer look at the nerves- structure. The dorsal root ganglion is closer to the spinal cord than the paravertebral facet joint nerve. These are not the same anatomic structures, so coding 64622-64627 for RF of the dorsal root ganglion is incorrect.
 
Why coders choose it: -These are valid codes and are easy to report and to be reimbursed for,- says Marvel Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver. -You have reasonable diagnoses to support medical necessity and don't have to send extra documentation with the claim.-

But easy coding doesn't always correspond with correct coding.
 
The problem: -Per CPT instructions, the codes you submit can't merely approximate the service provided--they need to match the service,- Hammer explains. -The dorsal ganglion root is not the same structure described by these codes. If you report these codes, you-re not being compliant.-

Superbill pitfall: The coders who report this procedure with 64622-64627 probably do not see RF of the dorsal root ganglion very often, says Myriam Nieves, CPC, ACS-PM, owner of the consulting firm Precision Medical Systems in Ft. Lauderdale, Fla. -This also can be particularly true for coders who mostly code from superbills or encounter forms,- she adds. -The superbill code descriptions often are condensed by removing the -paravertebral facet joint nerve- wording and therefore might be misused.- Check Your Definition of -Peripheral- Many coders believe 64640 is appropriate for reporting RF of the sacroiliac joint, and consequently think it should work for RF of the dorsal root ganglion because of its nearby location. But does it really apply?

The answer depends on your provider's opinion of the term -peripheral.-

Stedman Medical Dictionary's definition of peripheral states, -Situated near the periphery of an organ or part of the body in relation to a specific reference point.- Periphery is defined as, -The part of a body away from the center; the outer part or surface.-

Why coders choose it: The dorsal root ganglion is immediately off [...]