RFA Sacroiliac joint, L5, S1, S2 and S3

lcole7465

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Some input on this claim would be greatly appreciated. I'm having a hard time finding a dx that MMO will pay on this procedure. Diagnosis used: M46.1, M53.3, M47.817. Everything I'm finding is showing it should be coded as 64640 x4. Some information I've found is saying it should be coded as 64635 x1; 64636 x3. But I don't see that they are going anywhere other than the sacral area.

Report:

I used lidocaine 2% for skin infiltration. I used a 22-gauge, 10-mm Active Tip needle. I advanced the needle until I had good position of the needle into the junction between the sacral ala and the superior articular process of S1. Then we identified the most median and superior part of the SI joint. I advanced the needle towards the most lower and inferior portion of the SI joint on the left side until I had good position of the needle into the above level in the AP and lateral views. The following technique was used to confirm placement at the median branch nerves.
Sensory stimulation was applied to each level at 50Hz; parethesias were noted below 0.6 micro volts. Motor stimulation was applied at 2Hz with 1 millisecond duration; corresponding paraspinal muscle twitching without extremity movement was noted. Following this, the needle trocar was removed and a syringe containing 0.25% bupivicaine was attached. At each level, after syringe aspiration with no blood return, 1mL of 0.25% bupivicaine was injected to anesthetize the median branch nerve and surrounding tissue. After completion of each nerve block, a lesion was created at that level with a temperature of 80 degrees Celsius for 90 seconds X 2 lesions. All injected medications were preservative-free. Sterile technique was used throughout the procedure.

Thanks in advance
 

bdcoyne8

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There is actually a new code for 2020 for Sacroiliac RFA's. For S1, S2, S3, we now use the 64625 and S4 is 64640. So if S1-4 was performed it's billed 64625, 64640. We use M461 almost always or the M47817 we have not gotten a denial.

If it's prior to 2020, 64640x4 is correct. 64635-64636 is for the lumbar spine.
 

mah3434

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There is actually a new code for 2020 for Sacroiliac RFA's. For S1, S2, S3, we now use the 64625 and S4 is 64640. So if S1-4 was performed it's billed 64625, 64640. We use M461 almost always or the M47817 we have not gotten a denial.

If it's prior to 2020, 64640x4 is correct. 64635-64636 is for the lumbar spine.
Which place of service are you billing this in? We are getting denials stating it is not performed in the correct place of service.
 

lcole7465

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Since the new code covers S1-S4, if the provider includes L5 should we be coding 64635? Or would this be included since it's only the one level of the lumbar region.
 
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