Anesthesia Coding Alert

" Increasingly, pain specialists use radiofrequency (RF) to treat patients with intractable lower back pain. Various CPT codes may be used to describe the treatment, depending on the nerve destroyed by this technique, which is typically performed in the outpatient setting.
 
Although CPT lists several codes that may be used to report this treatment (or any other technique that involves nerve destruction), RF may also be performed on several nerves, such as the ganglion lumbar nerve, that are not described by existing codes.
 
In such cases, coders may need to use either: (1) a general code that describes the destruction of other peripheral nerves; or (2) an unlisted code, for RF treatments that involve other nerves or no nerves.
What Is Radiofrequency?
Radiofrequency is often used to denervate the facet nerve. This treatment (also known as facet neurotomy, facet rhizotomy or articular rhizolysis) relieves pain caused by degenerative changes in the posterior lumbar facet joints that cause lower back pain (that may radiate to the leg). RF facet denervation can stop the pain, and is often more effective than other neurolytic (nerve-destroying) agents, such as phenol, alcohol and hypertonic saline, because it lasts longer and does not diffuse randomly. The treatment may be indicated if facet joint or median branch injections relieve the patient's pain. RF techniques involve the use of fluoroscopy to position an electrode through which heat or electrical current passes, destroying nearby tissue.
 
Although radiofrequency techniques are used increasingly for therapeutic pain management, they remain a last-resort treatment for patients with certain conditions, such as lumbar spondylosis, when less drastic treatments such as lumbar epidurals or facet injections do not achieve the desired effect, says Lisa Clifford, CPC, a pain-management coding and reimbursement specialist in Naples, Fla.
 
Other conditions that may warrant radiofrequency lesioning include:
  medial branch nerves for facet pain
  L2-DRG (dorsal root ganglion) lesions
  diskogenic pain
  selective DRGs for radicular pain
  gray-ramus commuicante lesions for vertebral body compression fractures/lesions
  sympathetic ganglia for chronic regional pain syndrome (CRPS) Types I and II
  celiac plexus lesions for intra-abdominal pathology treatment of cervicogenic headaches with cervical medial branch nerve lesions
  cervical DRG lesions
  sphenopalatine ganglion, gaussian ganglion and/or trigeminal branch lesions for selective head and neck pain syndromes
  spinal stenosis.
The treatments deliver a pulsed or heat lesion via a generator that is programmed for the appropriate radiofrequency cannula (tube). Two pulsed lesions of 120-second duration at 42 degrees Celsius typically are applied at each site. If a heat lesion is delivered, a temperature of 80 [...]