Neurology & Pain Management Coding Alert

Question: One of my physicians wants to perform a radiofrequency of the knee. His recent office notes show that the patient’s chief complaint is knee pain due to neuroma and chronic osteoarthritis. The doctor has “drained and injected the neuroma multiple times without lasting decrease of pain.” I’m thinking the radiofrequency is probably investigational/experimental and doesn’t have an assigned code. What do you recommend?

Massachusetts Subscriber

Answer:  First, clarify the intended procedure and treatment area. A physician would not perform a radiofrequency ablation of the patient’s knee. The destructive procedure could be performed on a nerve that innervates the knee, but not the knee itself. 

The neuroma could potentially be on one of the cutaneous nerves of the knee. Choices include the intermediate femoral cutaneous, lateral femoral cutaneous, medial femoral cutaneous, posterior femoral cutaneous, lateral sural, and infrapatellar branch of the saphenous nerve. Finding references to any of these nerves in your physician’s documentation will help you better understand what you’re coding.

Additionally, a neuroma is a nerve tumor which typically doesn’t require draining. More likely, the physician performed an intra-articular knee aspiration to drain the knee joint itself due to the patient’s osteoarthritis (which would have been coded as 20610, Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]). 

Current codes: Depending upon whether the physician documents a specific nerve for the radiofrequency destruction, it may or may not be appropriate to code with 64640 (Destruction by neurolytic agent; other peripheral nerve or branch). If the physician performs radiofrequency ablation of a general area (that is, he doesn’t document specific nerve[s] to be treated), you should report the procedure with 64999 (Unlisted procedure, nervous system) and include supporting documentation of the service rendered.

Payer coverage of the procedure could vary widely. It’s always best to check with the patient’s insurance before scheduling the treatment.