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cryoneurolysis of coccygeal nerves

  1. #1
    Exclamation cryoneurolysis of coccygeal nerves
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    I am needing help with this op note please! Not sure I have picked out the right codes. The op note reads as follows:

    preop dx:
    1. coccydynia
    2. complex reginonal pain syndrome low back and buttocks
    3. lumbar degenerative disc disease

    postop dx:

    Procedure: the pt was placed in prone position on the fluroscopy table. the low back and buttocks were prepped times 3 with alcohol and betadine and allowed to air dry and sterilely draped. A skin wheal was raised above the sacral hiatus and a stab wound was made with an 11 blade scapel. Through the stab wound was advanced the chisel point cryoneurolysis probe. This was advanced into opening of the sacral hiatus in the anatomical area of the coccygeal nerves. AP and lateral views were checked under fluroscopy. Following this a series of freezes and de-thaws were carried out; each freeze 3minutes followed by a de-thaw of 1 minute. The probe tib was repositioned. A series of 4 of the freezes was carried out in the sacral hiatus. The probe then was turned caudally and aimed towards the coccyx and where the tip of the probe was placed at the junction between the sacral and the coccyx; two mmore lesions were made on each side of the proximal part of the coccyx. Each lesion was 3 minute freeze. The probe then was removed intact, the wound was closed using steristrips and sterilely bandaged, and taken to the recovery area in satisifactory condition.

    Anyone have an idea what to code ? I could find lots of information on how this procedure is done just not what CPT code is best to use. Looking at 64640 or possibly the facet joint injection?

    Thanks !!

  2. #2
    For CPT 2000, the destruction by neurolytic agent (eg, chemical, thermal, electrical, radiofrequency) codes 64622-64623 were revised, and two new codes 64626-64627 were established to delineate paravertebral facet joint nerve destruction by a neurolytic agent at the cervical or thoracic region(s).

    Above is from CPT Assistant, I was trying to determine if freezing the nerve was included in "destruction by neurolytic agent"

    The last facet joint level L5-S1 would not be associated with the coccygeal nerves so I would not use these codes. For 64640, I would review the defintion of "thermal" and see if could apply to your scenario.

    Another option, you could bill it unlisted and see how they respond when they review the procedure note. This way after billing a couple unlisted you can see they cover this type of procedure versus billing with 64640 and they are not really aware of what actually is being performed.

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