# RFA Sacroiliac joint, L5, S1, S2 and S3



## lcole7465 (Jan 29, 2020)

Some input on this claim would be greatly appreciated. I'm having a hard time finding a dx that MMO will pay on this procedure. Diagnosis used: M46.1, M53.3, M47.817. Everything I'm finding is showing it should be coded as 64640 x4.  Some information I've found is saying it should be coded as 64635 x1; 64636 x3. But I don't see that they are going anywhere other than the sacral area.

Report:

I used lidocaine 2% for skin infiltration. I used a 22-gauge, 10-mm Active Tip needle. I advanced the needle until I had good position of the needle into the junction between the sacral ala and the superior articular process of S1. Then we identified the most median and superior part of the SI joint. I advanced the needle towards the most lower and inferior portion of the SI joint on the left side until I had good position of the needle into the above level in the AP and lateral views. The following technique was used to confirm placement at the median branch nerves.
Sensory stimulation was applied to each level at 50Hz; parethesias were noted below 0.6 micro volts. Motor stimulation was applied at 2Hz with 1 millisecond duration; corresponding paraspinal muscle twitching without extremity movement was noted. Following this, the needle trocar was removed and a syringe containing 0.25% bupivicaine was attached. At each level, after syringe aspiration with no blood return, 1mL of 0.25% bupivicaine was injected to anesthetize the median branch nerve and surrounding tissue. After completion of each nerve block, a lesion was created at that level with a temperature of 80 degrees Celsius for 90 seconds X 2 lesions. All injected medications were preservative-free. Sterile technique was used throughout the procedure.

Thanks in advance


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## bdcoyne8 (Jan 29, 2020)

There is actually a new code for 2020 for Sacroiliac RFA's. For S1, S2, S3, we now use the 64625 and S4 is 64640. So if S1-4 was performed it's billed 64625, 64640. We use M461 almost always or the M47817 we have not gotten a denial. 

If it's prior to 2020, 64640x4 is correct. 64635-64636 is for the lumbar spine.


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## lcole7465 (Jan 29, 2020)

Yes, it was prior to the new code for 2020... 

Thank you


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## mah3434 (Feb 4, 2020)

bdcoyne8 said:


> There is actually a new code for 2020 for Sacroiliac RFA's. For S1, S2, S3, we now use the 64625 and S4 is 64640. So if S1-4 was performed it's billed 64625, 64640. We use M461 almost always or the M47817 we have not gotten a denial.
> 
> If it's prior to 2020, 64640x4 is correct. 64635-64636 is for the lumbar spine.


Which place of service are you billing this in? We are getting denials stating it is not performed in the correct place of service.


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## bdcoyne8 (Feb 6, 2020)

POS 22. These are done in our clinic. We are an Hospital based clinic.


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## lcole7465 (Feb 14, 2020)

Since the new code covers S1-S4, if the provider includes L5 should we be coding 64635? Or would this be included since it's only the one level of the lumbar region.


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## bdcoyne8 (Feb 14, 2020)

You would include the 64635 as it is specific to the lumbar spine.


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## terri.carpenter@msj.org (Mar 11, 2020)

Help,  I have confused myself by searching for Procedure code for- Destruction other peripheral nerve/branch.  I am not sure if CPT 64640 should be billed or the new CPT 64625.  All help is appreciated.
Procedure note:


Terri Carpenter


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## Jenn6622 (Aug 7, 2020)

You cannot bill the 64625 and the 64635 together.


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## PGARCIA (Aug 25, 2020)

64625 X 1


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## afaustina1 (Apr 22, 2021)

mah3434 said:


> Which place of service are you billing this in? We are getting denials stating it is not performed in the correct place of service.


So we are Location 22 (On Campus Outpatient Hospital). Medicare has been paying the 64625, but some supplemental insurance payors are not (like Florida Blue and other Out of State BC/BS supplemental insurances. Also Tricare For Life is not paying.  They consider it  Experimental and Investigational. Initially, Tricare For Life was denying payment for 64451 even after Medicare payed their portion. I found a wonderful contact there and she went to Department of Defense and they added the new code for 64451, however, the 64625 is on their No Pay List and will most likely not be changed. So just wondering if anyone has a CURRENT code for Radiofrequency Ablation of the SI Joint nerves other than the 64625 that is being denied as Investigational and Experimental. 
Many Thanks for your insight!
V. Marie de Zerne, CPC


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