Wiki RF - "internally cooled electrodes"

[sarthur]

A rep is trying to sell my Dr's on cooled radiofrequency treatment supplies for our cervical and lumbar RF's. I responded with the guidance from the 2017 CPT book about anything less than 80 degrees C being 64999 instead of 64633-64636. I was then told that they use internally cooled electrodes but that the tissue temperatures reach above the 80 degree C threshold so 64633-64636 are applicable. The sales brochure states: "By internally cooling the surface of the electrode, much more energy can be supplied by the RF generator resulting in much larger coagulation volume while operating at a lower temperature setting, 60 C and reaching tissue temperatures up to 80-90 C."

I still think this falls under 64999 but am I wrong? Does anyone else have experience with this or supporting documentation one way or the other that isn't from someone trying to sell something?

View attachment Halyard Tech Note_CRF 60 vs 80.pdf

 

[dwaldman]

I would look at the medically policies of the carriers you are billing to see if they mention limitations. I noticed UHC does not mention "cooled" RF in their policy, but they do describe the treatment that they cover as "Thermal" which appears to not be the same as "Cooled" As seen below a larger lesion can be obtained with cooled but they also describe using lower temperatures. The rep you were talking to mention the required temperature but I don't believe just the fact it being cooled makes it unlisted. This is not the best information regarding the subject because I am not very familiar with coding for "Cooled" Radiofrequency Ablation.

https://www.unitedhealthcareonline....licies/Ablative_Treatment_for_Spinal_Pain.pdf


Thermal radiofrequency ablation of facet joint nerves is proven and medically necessary for chronic......


Cooled Radiofrequency Ablation vs. Thermal Radiofrequency Ablation

https://clinicaltrials.gov/ct2/show/NCT02073292
There are several types of probes or needles that are used to transmit energy and create lesions. This study is going to compare 2 types - standard radiofrequency and 'cooled' radiofrequency. The only difference is that the 'cooled' radiofrequency probes have water running through the probe tip, which keeps the tip cool and allows a larger lesion to be made. Since the doctor can't actually see the nerve he is trying to target, the larger lesion should theoretically improve his chances of hitting it. The 'cooling' of the water also allows the temperatures to be lower than what is needed for standard RF.