Wiki RFA of Lumbar facet joint and Sacral nerves

[gelisan]

Need help how to code properly for Sacral nerves S1-S3 in addition to Lumbar facet joint L4-S1 radiofrequency ablation. According to my online research and articles, the correct way to code the sacral nerves is to use 64640 since there is no paravertebral facet joint in the sacrum and what is being ablated or treated is the lateral branches, is this correct? Our provider is performing both of this procedures and provided a diagnosis M47.817. Cpt code 64635 and 64640 has each own LCD and the diagnosis code for M47.817 is not listed that supports medical necessity for 64640. One of the coder have asked, based on the cpt code description of 64635, it includes the sacrum, would it be be correct to assign the 64635 and 64636 for the sacral nerves ablation since this is being done for lumbosacral spondylosis? Please help so I can better explain this to our providers. Thank you

 

[krithika]

hi,

For coding RFA or RFTC, we need to check the nerve branch which is ablated.

If it is medial nerve branch, then we need to code ablation/destruction of paravertebral joint. ie 64635 and 64636 for lumbar and sacral joints.

if it is lateral nerve branch, then we need to code ablation/destruction of other peripheral nerves. ie 64640

In general, lateral branch RFTC only done for sacral joints(S1,S2 and S3). hence we code 64640. Hope this is helpful.