RFA for lumbar sympathetic chain ?


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We have been researching to find the appropriate code for RF destruction of paravertebral lumbar sympathetic chain. One of our doctors dictates it as follows:
1. Procedure Line states- RF of left L2, L3 and L4 lumbar sympathetic chain.
The body states: A series of 3 individual curved RF needles were then placed into the anterolateral aspects of each vertebra being L2,L3 and L4. The position was confirmed to be along the sympathetic chain with 1-2 cc of Omnipaque 300 at each one of the three needles. The patient then underwent motor and sensory testing. Each of the 3 medial nerve branch nerves were then anesthetized with bupivacaine. The patient then rec'd RF ablation at each level with two lesions being 60 seconds in duration at 80-C with normal impedence.

I have coded this as a regular lumbar RF lesioning 64622-23 in December of 2011. I now would code this as 64635-36 in 2012. But we are being told to use 64640 by one of the physicians and we need affirmation from a reliable source for a coding round table with the doctors.
Linda Vassallo, CPC


True Blue
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64635 is for paravertebral facet joint nerves which is not the same service.

Part of a private response I received from the AMA CPT Network,

“Based solely upon the information provided in your electronic inquiry, from a CPT coding perspective, there is no specific CPT code to describe “left radiofrequency lesioning of the lumbar sympathetic chain”. Therefore, code 64999, Unlisted procedure, nervous system, should be reported once even though the radiofrequency ablation was performed at more than one spinal level. When performing two or more procedures that require the use of the same unlisted code, the unlisted code used should only be reported once to identify the services provided. This is due to the fact that the unlisted code does not identify a specific unit value or service. Unit values are not assigned to unlisted codes since the codes do not identify usual procedural components or the effort/skill required for the service."