Wiki Genicular Nerve Radiofrequency Ablation prior to TKR

[574coding]

Hello,
One of our pain management providers has been contacted by an orthopedic surgeon about GNRFA prior to TKR. Does anyone have any sucess with reimbursement on the GNRFA? Do we need to make sure the patient has has prior knee injections by the ortho surgeon or other provider that have been unsucessful before we provide the GNRFA? I know Medicare does not have an LCD for 64624. I am not sure where to find guidelines on this topic.
THank you

 

[amyjph]

I have seen it performed & coded but unsure if it was paid/covered or experimental. It might have to be self pay. I think it also depends on injection vs. destruction. I'm sure you saw this too but all I could find was an NCS Article: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57452&ver=23&

I looked at Cigna as an example and it's experimental for pain. https://static.cigna.com/assets/chc...tioncriteria_peripheral_nerve_destruction.pdf
Aetna says experimental for pain too: http://www.aetna.com/cpb/medical/data/800_899/0863.html
Anthem: https://www.anthem.com/dam/medpolicies/abc/active/policies/mp_pw_c187107.html
Investigational and Not Medically Necessary:
Genicular nerve blocks and genicular nerve ablation are considered investigational and not medically necessary for the treatment of chronic knee pain, including but not limited to any of the following:

• Degenerative joint disease;
• Osteoarthritis of the knee;
• As a treatment prior to knee replacement;
• As a treatment following knee replacement;
• As a treatment for individuals who are not candidates for knee replacement surgery

 

[talexander@ciproms.com]

The key is in the coding and the reason. Is the GNRFA for the reason for TKR like OA or is it really for post operative pain management. Our provider is doing it for post operative pain management and therefore it is a diagnosis of G8918 and falls into treatment following knee replacement and post op pain management under most plans, you do however have to explain this to your carrier many times on appeal. We have an appeal letter that works sometimes. We do typically get them paid though.

 

[amyjph]

The key is in the coding and the reason. Is the GNRFA for the reason for TKR like OA or is it really for post operative pain management. Our provider is doing it for post operative pain management and therefore it is a diagnosis of G8918 and falls into treatment following knee replacement and post op pain management under most plans, you do however have to explain this to your carrier many times on appeal. We have an appeal letter that works sometimes. We do typically get them paid though.

Good point. I do remember seeing it paid when it was post-op chronic pain due to TKA.