64640 vs 64999 for a saphenous nerve rfa

calatv

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Hi,
Our provider performed a left saphenous nerve radiofrequency ablation. However, in his op notes, he states the radiofrequency was performed for 60 seconds at 60 degrees Celsius.

I know CPT guidelines state the following:

"Do not report 64633, 64634, 64635, 64636 for non-thermal facet joint denervation including chemical, low-grade thermal energy (<80 degrees Celsius), or any form of pulsed radiofrequency. To appropriately report any of these modalities, use 64999."


I may be splitting hairs, but 64640 isn't listed in that restriction. So would we be able to code 64640? Or go with 64999?

Any guidance would be greatly appreciated! Thanks!
 

dwaldman

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I agree they don't address peripheral nerves.

I noticed UnitedHealthcare doesn't necessarily use the AMA parenthetical instruction and describe as below:

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/ablative-treatment-spinal-pain.pdf

Thermal Radiofrequency Ablation is defined as follows:
 Temperature ≥60° Celsius; and
 Duration of ablation ≥40 seconds; and
 Confirmation of needle placement by fluoroscopic guided imaging

Pulsed Radiofrequency Ablation: Technique that delivers intermittent bursts of current, instead of continuous
current, using a probe temperature of 42°-45° Celsius (Hayes, 2016a; updated 2017).
 
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