# Radiofrequency??



## abarajas

Can someone please verify which cpt for radiofrequency is correct? I see anywhere from 6262_ to unlisted 64999 to 64040 and even just 64483 

Any reference to where I can get supporting documentation is truly greatly appreciated.

Thanks.


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## dwaldman

Codes 64622-64627 describe Non-pulsed radiofrequency ablation of the paravertebral facet joint nerves

Code 64999 is reported for pulsed radiofreqncy ablation

There would not a scenario that 64483 would be used for radiofrequency ablation procedure because the code descriptor describes the performance of epidural using the transforaminal approach

In 2012 64622-64627 will be deleted and replaced with 64633-64636.

AMA offers CPT Assistant as online  program with archives and  current issues available sooner than quartely like other online coding software. Audio Educator has pain management coding webinars


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## dwaldman

I forgot to mention 64640. A question was submitted by Karen Glancy CCS-P to the AMA and they published this question and answer in December 2009 CPT Assistant Here is part of this Q and A and how 64640 is reported for lateral branch nerve destruction that innervate the sacroilliac joint 

"The sacroiliac (SI) joint and sacral anatomy differs in that it is comprised of spine bone and pelvic bone wherein the exact innervation of the SI joint occurring more from contri-buting branches at adjoining nerve levels. Procedurally, the work of the described SI joint destruction differs from that described by code 64622, Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level. Code 64622 may be reported for L5-S1 rhizotomy (nerve destruction since this joint lies between two spinal segments for which the anatomy and procedural work at L5-S1 is similar to that at other spinal segments (eg, L4-5). Therefore, the unlisted nervous system code 64999 would be reported once for SI joint or sacral rhizotomy (nerve destruction).

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."


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## abarajas

Thank you for the information TrueBlue, truly appreciate it


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## dwaldman

Another thing to consider if you are looking a radiofrequency procedures is the changes in codes and the changes to reporting due to the changes in the code descriptiors that will be effective Jan. 1st 2012.

In AMA CPT Assistant, September 2004 they describe the reporting for a facet joint block as per facet level or medial branch block where two nerve might be injected but would still be reported per facet level innervated by those nerves. In contrast they describe that the radiofrequency procedures could be reported per nerve treated:

".....a left-sided L4-L5 intra-articular injection performed with a single needle puncture would be coded as 64475. Injection of the L3 and L4 medial branch nerves supplying the L4-L5 facet joint would also be coded as 64475, even though two separate injections are performed to effect the same result."

"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."

In contrast in 2012 CPT Changes:

64633 Destruction by neurolytic agent, paravertebral facet joint nerve(s) with imaging guidance (fluroscopy or CT); cervical or thoracic; single facet joint

64634 cervical or thoracic, each additional facet joint (List separately in addition to code for the primary procedure)

64635 lumbar or sacral; single facet joint

64636 lumbar or sacral; each additional facet joint (List separately in addition to code for primary procedure)

"The paravertebral facet joint nerve codes 64622, 64623, 64626, and 64627 have been deleted. Four new codes have been established to more accurately reflect the work and anatomical site involved in these proceures. Prior to 2012, the unit of service used to report these procedures was a single nerve at a single vertebral level. However, two nerves innervate each facet joint, and there are two facet joints at each vertebral level. One or two facet joints at the same level potentially could be treated. As such, the vertebral level is of less significance than the number of facet joint treated, so using vertebral level as the unit of service is a single facet joint in new codes 64633, 64634 , 64635, and 64636, rather then a vertebral level."


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## tdavitt

*2012 RF codes*

Can anyone tell me if I am correct then in understanding that billing for a radiofrequency with the new radiofrequency codes will be like billing for a medial branch block using the facet joint codes.

Example: RT L4 L5 S1 Medial Branch Block
64493-RT
64494-RT

So then would a RT L4  L5  S1 Radiofrequency be:
64635-RT
64636-RT

Where as for 2011 the correct coding for a RT L4  L5  S1 Radiofrequency would be:
64622-RT
64623-RT
64623-RT-76

Any one have any thoughts?


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## brockorama01

I believe the coding is the same, just the codes have changed.  It's NOT like MBB's where four levels would be 64493, 64494, 64495.   Four levels of RF will be 64635, 64636, 64636, 64636.

Brock Berta, CPC-A


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## dwaldman

In 2012, The coding has changed and it is per facet joint level. They changed paravertebral facet joint nerve to the plural form in the descriptor as nerve(s). This supercedes the the guidance from September 2004 CPT Assistant and the code descriptor has changed significantly for nerves being changed plural and the language of single facet joint in the descriptor.

As seen below an excert from  AMA CPT Changes 2012, "a unit of service is a single facet joint"

"Prior to 2012, the unit of service used to report these procedures was a single nerve at a single vertebral level. However, two nerves innervate each facet joint, and there are two facet joints at each vertebral level. One or two facet joints at the same level potentially could be treated. As such, the vertebral level is of less significance than the number of facet joint treated, so using vertebral level as the unit of service is a single facet joint in new codes 64633, 64634 , 64635, and 64636, rather then a vertebral level."


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## abarajas

Radiofrequency done with Simplicity Probe S1-S4? I don't understand why it should be unlisted if the nerves are being destroyed.


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## bella2

Please see CPT Asst Dec. 2009, as they specifically state the use of the Simplicity 1 probe would be the unlisted code 64999. As with the Simplicity Probe they are using a single
electrode with multiple contacts that are being advance to the nerves. 64640 would be used if the individual nerves S1,S2 for example were being injected.

Hope this helps,
Cheers,
Bella


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## abarajas

It does, thank you


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## CLAUDIA78

I have a question, Doctor has done 64633 & 64634 x 2 however he also is asking me to bill for the radiofrequency needle can I do that?


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## dawnebrennan

*Dawn*

The reason for using unlisted code 64999 is that in pulse radiofrequency, the provider is not destroying the nerve.  With pulse radiofrequency the effects of the treatent are temporary not permanent as in codes 64600-64640.


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