# Radiofrequency ablation basivertebral nerve at L5 and S1



## coder067 (Feb 17, 2014)

I am thinking 64640 but not sure. Does anybody know?

Thanks!


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## dwaldman (Feb 17, 2014)

The rationale for the procedure is based on studies indicating that the basivertebral nerve conducts pain receptive signals from intraosseous sources. Previous researchers had described consistent reports of a severe ?deep boring pain? when the bony endplate was directly stimulated during surgical procedures performed on nonanesthetized patients. Pathologic changes (including edema and inflammation), within the bone adjacent to degenerating lumbar disks and noted on magnetic resonance images, suggest that clinical pain could be addressed by ablatement of the intraosseous nerves within the anatomic area where these nerves enter the bone.

Treatment was performed using intraoperative fluoroscopy and a transpedicular approach (Fig. 1). A bipolar radiofrequency probe with a curved obturator, inserted through a bone biopsy needle, was guided to the target. Then, bipolar radiofrequency energy was used to ablate the basivertebral nerve in a controlled manner. Treatment was limited to L3, L4, L5, and S1 vertebrae. Two- and three-level intraosseous ablatements were performed, always at adjacent levels; 12 patients were treated at L4-L5, 2 at L3 through L5, and 2 at L5-S1. 

http://www.aaos.org/news/aaosnow/jan12/clinical4.asp

I looked at the above article to become more familiar with this procedure. I am not sure if this is unlisted procedure code or 64640. Potentially would have to get clarification from AMA CPT Network.


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## dwaldman (Dec 14, 2018)

For 2019, there appears to be new HCPCS codes established for this procedure

C9752	Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum

C9753	Destruction of intraosseous basivertebral nerve, each additional vertebral body, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum (list separately in addition to code for primary procedure)


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