cryoablation ilioinguinal nerve cpt code help

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Can someone please help me find a px code for this? So far-I think I'll have to use 64999.
CT-guided cryoablation of right ilioinguinal nerve between the transversus abdominis and internal oblique muscles at the anterior superior iliac spine.



Informed consent was obtained. A discussion was held with the patient. We discussed post herniorrhaphy neuropathic pain, the indication for the procedure. The nature of how I would perform the procedure including: placement of a cryoablation needle near the nerve under direct CT guidance followed by ablation with an ice ball was discussed. The risks including bleeding, infection, injury to adjacent organs, and incomplete ablation incomplete therapy were discussed. The likelihood of technical success, (approximately 50%) and benefits (pain relief) were discussed. This information was given in a language understandable to the patient. All questions and concerns were answered.

A timeout was performed prior to the procedure. The patient was placed in the supine position. Moderate sedation was used throughout the procedure. A scout CT was obtained. The right lower abdomen was prepped and draped in the usual sterile fashion. The skin was anesthetized with one percent lidocaine local anesthesia and a small skin incision was performed.

The subcutaneous tissues and muscle were anesthetized with 10 cc of 2% lidocaine and 10 cc of 0.5% bupivacaine.

Utilizing CT fluoroscopy a 17 gauge Galil CryoSeed needle was introduced between the transversus abdominis and internal oblique muscles at the right anterior superior iliac spine. A standard cryoablation protocol was then performed (10 minute freeze, 5 minute thaw, 10 minute freeze, 5 minute thaw). This was monitored with periodic CT fluoroscopic images documenting increase in size of the ice ball during freezing.


Denver Colorado
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Won't help you with this date of service, but effective July 1, 2016 there will be new Category III codes for cryoablation:
0440T Ablation, percutaneous, cryoablation, includes imaging guidance; upper extremity distal / peripheral nerve
0441T …; lower extremity distal / peripheral nerve
0442T …; nerve plexus or other truncal nerve (eg, brachial plexus, pudendal nerve)

FYI: some commercial payers consider cryoablation to be investigational / experimental