# Radiofrequency Ablation SI Joint



## Barb Tucker (Jul 17, 2012)

Can any one please read over the following op note to see if we are coding correctly?
We are an ASC and we bill

64640 LT
64640 59 LT
64640 59 LT
64640 59 LT
64640 59 LT
64640 59 LT
77003 TC


Side: Left

Level: Sacroiliac Joint

Supplies : lidocaine 1%, bupivicaine 0.25%, Eight 10cm RFA needles. 


Description : The risks, benefits, and options were explained to the patient, and written and verbal consents were obtained. The patient was brought to the procedure room and placed in the prone position. After sterile prep and drape of the lumbar and buttocks region to include the sacroiliac joints to be treated, the targeted sacroiliac joint was identified with fluoroscopy. Prior to skin entry, lidocaine 1%-1 cc was used for local skin anesthetic. A total of eight 10 cm radiofrequency ablation needles were placed along the medial border of the visualized sacroiliac joint under fluoroscopic guidance, which involved individualization fluoroscopic guidance of each of the eight needles. Once the bone was contacted, both AP and lateral views were obtained confirming that there were no intraforaminal placements of any of the involved needles. All potential lesion sites were negative for motor stimulation at 2 volts. Lidocaine (1% total volume of 1 cc) was given at each radiofrequency ablation site in order to anesthetize prior to the lesioning. Radiofrequency ablation lesioning took place at 80-degree Celsius for 90 seconds per radiofrequency ablation needle for a total of eight lesions. The therapeutic treatment for the distal branches of the following nerves, which encompassed the innervation of the sacroiliac joint, the distal branch of L2 medial branch, the distal aspect of L3 medial branch, the distal aspect of L4 medial branch, the distal portion of L5 medial branch, the distal portion of the S1 medial branch, and the distal portion of the S2 medial branch, the L5 ventral rami distal portion, S1 ventral rami distal portion, and S2 ventral rami distal portion, which are all involved in the anterior SI joint innervation. Additionally, the posterior sacroiliac joint branches that had been treated also included L4, L5, S1, S2, S3, and S4 medial branches in the distal aspect prior to its entry of the sacroiliac joint itself. In summary, the radiofrequency ablation encompassed all nerves referred to above with the denervation taking place at the distal branch of those, which are peripheral innervations of the sacroiliac joint. 

Although eight lesions took place, there will only be six lesions billed for on the claim because of the assurance that six peripheral lesions were done that would capture six separate distal aspects of the nerves listed above in order to get a therapeutic response for the sacroiliac joint, by decreasing the pain so that the patient can have an increased quality of life and try to decrease any narcotic usage.

Thank you for your valuable time!
BT


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## maryc@trgltd.com (Jul 19, 2012)

*Reference from 2009*

Good afternoon!

Please see the attached scenario from CPT Assistant in 2009.  I believe it describes your note in strong detail.

I think that this provides the back-up for the coding selections that you had proposed.

Good luck!  

Mary Corkins
TRG
www.trgltd.com


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## Barb Tucker (Jul 20, 2012)

Thank you Mary, I have been searching CPT Assistant and could not find this.


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