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Pain Management - position to lesion

  1. Default Pain Management - position to lesion
    Medical Coding Books
    Does anyone know how you would code a Radiofrequency Simplicity III electrode.

    Done on the S1 S2 S3 and S4, states 3 contacts were in the appropriate position to lesion. Lesioning was carried out using the Simplicity III Pre-program protocol at 85 degrees centigrade for 5 minutes.



  2. #2
    The CPT is 64622, 64623 and we list the probe as L9900.

  3. Default Radiofrequency Simplicity III
    Craig thanks so much for the information, we was not sure as to the 64622 because there was an Anesthesia and Pain Management Coding Alert that went out about Pulse Radiofrequency have seen this article. States to use Code 64999 states they use a probe to stun the nerves.

    Please let me know.


  4. Default
    this should not be coded as 64622 but as cpt 64640 there is a CPT assistant out on this, I will locate if for you. 64622 is used for paravertebral/facet radiofrequency. there are no facets/median branch below L5-S1.

  5. Default
    Hi, Betsyrivera did you by chance find the CPT Assistant on this?

    Thanks for you help Kim

  6. #6
    Facet Denervation vs Facet Joint Nerve Injection or Destruction Procedure(s)

    If there is a favorable response to facet joint or facet joint nerve (ie, medial branch) injections, then more permanent techniques for the treatment of facet pain may be considered. In this instance, a destructive lesion of the medial branch nerve is performed, blocking the passage of painful messages from the affected facet joint to the rest of the central nervous system. The 64470-64476 series of codes should not be reported to describe denervation procedures.

    The destruction by neurolytic agent (eg, chemical, thermal, electrical, radiofrequency) codes (64622-64627) refers to paravertebral facet joint nerve destruction at the cervical, thoracic, lumbar, or sacral region(s). Codes 64622-64627 are unilateral. Therefore, if neurolytic destruction of the paravertebral facet joint nerve is performed at both the right and left sides, then modifier 50 should be appended to the appropriate code to indicate that bilateral procedures were performed. Also, if fluoroscopic guidance and localization for needle placement and neurolysis is performed in conjunction with codes 64622- 64627, then code 76005 should be reported separately in addition to codes 64622-64627. Unlike facet joint nerve (medial branch) codes used to describe facet joint injection (64470-64480), facet nerve destruction codes 64622-64627 refer to individual nerve level destruction. Thus, although injection of the left L3 and L4 medial (facet joint) nerve would be code as 64475, destruction of the L3 and L4 medial branch nerves would be coded as 64622 and 64623.

  7. Default
    I do have some information on this, Im at work right now so I will post it later this afternoon.

  8. Default
    This is from the "The Coding Institute"

    Your first step toward correct coding is to verify
    whether the physician performed the destruction within
    the SI joint itself or to the nerves that innervate the SI
    joint. Chances are, you’ll be coding for procedures that
    affect the surrounding nerves.
    “The injections often are performed on nerves that
    derive from the lateral branches of the S1-S3 dorsal rami,”
    explains Myriam Nieves, CPC, ASC-PM, director of
    coding and reimbursement for Axis Management and
    Billing Services in Hollywood, Fla. “Therefore, the
    provider’s documentation will most probably state that
    ‘Motor stimulation was performed at the SIJ medial
    branch nerves.’”
    Not so fast: Many coders rely on codes 64622
    (Destruction by neurolytic agent, paravertebral facet joint
    nerve; lumbar or sacral, single level) or 64623 (… lumbar
    or sacral, each additional level [List separately in
    addition to code for primary procedure]) for these
    injections, but that can be a mistake. Some basic
    knowledge of anatomy helps to show why:
    Reason 1: The paravertebral facet joint nerves don’t
    innervate the SI joint. Nieves believes that coders usually
    get confused because the descriptors of 64622 and 64623
    read “lumbar or sacral.” Coders who are not familiar with
    anatomy might think this justifies an injection in the
    sacroiliac joint.
    Reason 2: There are no paravertebral facet joints
    below the L5-S1 facet joint. Providers often perform
    destruction of some branches that innervate the SI joint
    (such as L5, S1, S2 and S3). These are not paravertebral
    facet joint nerves, so coding it as such is incorrect.
    Report RF More Accurately with 64640 or 64999
    So, if 64622 and 64623 aren’t accurate for reporting
    RF of the nerves surrounding the SI joint, what’s your best
    option? Many coders tend to agree that you have two
    viable alternatives, depending on the situation: 64640
    (Destruction by neurolytic agent; other peripheral nerve
    or branch) or an unlisted code, such as 64999 (Unlisted
    procedure, nervous system).

  9. Default Thanks

    Thank you very much.

  10. Default Coding 64400

    I am new to Pain Management Coding, but could you tell me if when a Pain Dr. does a Trigeminal nerve block and says he does 3 at the Facial nerve,Supraorbital nerve, and Supratrochlear, can you code 64400 three times.

    He is also doing Nerve Ablation the same way asking to code it three times with Code 64600.

    Is this correct or can you only code one time if they are all branches of the Trigeminal Nerve.

    Thanks for you help.


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