Anesthesia Coding Alert

Question: We report 64640 for radiofrequency ablation (RFA) of the sacroiliac (SI) joint. When the physician treats the lateral branches of the S1-S4 nerves, we either submit 64640 x 4 units or list each 64640 on a separate line, depending on the payer. Medicare is denying the claims based on the daily frequency or units. How should we handle this?

Rhode Island Subscriber

Answer: The carrier might deny your claim because, although 64640 (Destruction by neurolytic agent; other peripheral nerve or branch) is the best code choice for radiofrequency ablation of the nerves providing sensory innervation to the posterior SI joint, billing it four times within a session might be considered unusual.

Try this: Indicate the individual nerves destroyed (such as "S1, S2, S3, and S4 lateral branches") in Box 19 (or the electronic equivalent). If Medicare denies a claim you'll need to go through the appeals process, including sending your physician's documentation of the separate and distinct RFA of each of the four nerves. Also encourage your physician to include adequate documentation to support the medical necessity of the procedure.