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Pain management case

  1. Question Pain management case
    Medical Coding Books
    Hello, I am in a pickle with a new procedure at my ASC.

    The Op report is as follows:

    Radiofrequency thermal ablation of the left sacroiliac joint from S1 through S4 and L5 under fluoroscopic guidance.

    Procedure: The patient was taken to the procedure room. She was placed in a prone position. Site was marked. Pause was done. Aseptic preparation of the left side of the lumbar spine was done with Betadine. 3xx of 1% preservative free Xylocaine was inject into the subcutaneous tissue. 20 gauge RF cannula with 10 mm active tip was inserted into the left SI Joint starting from the S5 nerve root. Proper confirmation of the needle placement was done in AP, oblique and lateral views. After proper confirmation of the needle placement, the patient denies any pain or paresthesia. Total of 10 cc of Bupivacaine and 10 cc of 2% Xylocaine was injected in total to the five lesions. Total lesions were done at S4, S3, S2, S1, and L5. Duration of the lesions was 80 seconds and temperature of the lesions was 80 degrees. The patient tolerated the procedure very well.

    Not sure if 64622-Lt, 64623x3-LT, 64640-LT, & 77003-TC is correct.

    I have been looking all through the internet on how to code this case. I have not been very lucky. If anyone can please help me or direct me to a place that can....I would be very grateful!

    Thanks in advance.
    Kelly Sumansky, MA, CPC-H, CMC

  2. #2
    (These are my opinions and should not be construed as being the final authority. Other opinions may vary.)

    From the Dec 2009 CPT Asst:

    "To differentiate between the work when performing sacral nerve destruction of S1, S2, S3, and S4, each individually separate peripheral nerve root neurolytic block is reported as destruction of a peripheral nerve, using code 64640, Destruction by by neurolytic agent; other peripheral nerve or branch. In this instance, code 64640 is reported four times. It is suggested that Modifier 59, Distinct Procedural Service, be appended as well."

    In your case above, I would code 64640-LT, 64640-59-LTx4, 77002-TC

    64622 & 64623 are for Medial Branches, not Nerve Roots.

    Richard Mann, your pain management coder

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