# 64999



## TiffianyEdwards (Jan 27, 2015)

Where can I find a list of procedure descriptions for reporting box 18/19 for medicare unlisted procedures for code 64999?

Looking for reference info to bill radiofrequency ablation of nerves that supply the SI joint.


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## dwaldman (Jan 27, 2015)

CMS-1500- Item 19   Additional Claim Information (previously Reserved for Local Use)  
837P- LOOP 2300  Segment/Data Element NTE PWK 

I am not aware of a published descriptors for unlisted procedures.

If you are going to provide a CMS-1500 paper claim you would want to print the claim and ensure the descriptor you are going to use does not exceed the character limit available on the claim.


Some examples could be:

RF ABLATION SI JOINT NERVES

SACROILIAC JT NERVE ABLATION


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## dwaldman (Jan 27, 2015)

If you will need to submit the operative report you would want to confirm the physician is clear which procedure was performed and the technique used since it can effect the coding.

As seen below radiofrequency sacroiliac joint ablation (the joint itself) is considered and unlisted procedure per AMA CPT Assistant. 

In 2012 they published a Q & A that gave similar guidance to their 2009 article that stated: "each individually separate peripheral nerve root neurolytic block is reported as destruction of a peripheral nerve, using code 64640, Destruction by by neurolytic agent"

The 2009 article pointed out that a probe that simultaneously ablated multiple separate nerve branch sites would be reported unlisted.

You might also be encountering a contractor or payer that is requesting an unlisted procedure code for this service.

The procedure heading needs to be specific to identify the sacroiliac joint lateral branches with the side that was treated and total nerves. The narrative will have to support these levels and sides.  If the narrative is from template format it would need to be reviewed to match what was performed and consented for and briefly described in the procedure heading.

July 2014 page 8

Frequently Asked Questions:Surgery: Nervous System

Question: What is the appropriate code to report a radiofrequency sacroiliac joint ablation? 

Answer:There is no specific CPT code that accurately describes this service. Therefore, the unlisted code 64999, Unlisted procedure, nervous system, should be reported. When reporting an unlisted code to describe a procedure or service, it may be necessary to submit supporting documentation (eg, procedure report) along with the claim to provide an adequate description of the nature, extent, and the need for the procedure, as well as the time, effort, and equipment necessary to provide the service. 
______________________________________________________
June 2012 page 15

Frequently Asked Questions:Surgery: Nervous System

Question: May code 64640 be reported for each individual peripheral neurolytic nerve destruction procedure performed at the L5, S1, S2, and S3 nerves? 

Answer: Yes. When performing individually separate nerve destruction, each peripheral nerve root neurolytic block is reported as destruction of a peripheral nerve, using code 64640, Destruction by neurolytic agent; other peripheral nerve or branch. In this instance, for peripheral nerve root neurolytic blocks (destruction) of L5, S1, S2, and S3, code 64640 should be reported four times. The coder should append modifier 59, Distinct Procedural Service, to the second and subsequent listings of code 64640 to separately identify these procedures
____________________________________________________
December 2009 page 11

Bonus Feature:Surgery: Nervous System

Question: Should code 64640 x 4 be reported per lesion because it is a single percutaneous entry point or should the unlisted code 64999 be reported? What is the appropriate code to use for radiofrequency (eg, Simplicity III? Radiofrequency Probe) for sacroiliac (SI) joint nerve destruction from a single percutaneous entry site in the following procedure? 

The Simplicity III electrode was then advanced, maintaining continuous contact with the sacrum, on a cephalad and slightly lateral line, staying lateral to the sacral foramen, medial to the sacroiliac joint, and ventral to the ilium, until contact with the sacral ala prevented further advancement. Appropriate positioning was confirmed by changing the caudal/cephalad tilt of the C-arm to parallel the superior endplate of S1; and verifying once again that the entire length of the Simplicity III electrode was advanced to the ipsilateral sacral ala and the three independent, active contacts were positioned adjacent to the S1, S2, S3, and S4 lateral branch innervation pathways.... "Lesioning" was then carried out using the Simplicity III preprogrammed protocol at 85 degrees centigrade for five minutes. Karen Glancy, CCS-P

Answer: Since the documentation indicates insertion of a single electrode (having three contacts) at the sacroiliac (SI) joint "to lesion the lateral branches of S1, S2, S3, and S4," code 64999, Unlisted procedure, nervous system, is reported once. This "SI joint rhizotomy" would be reported once using the unlisted nervous system code 64999. 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 contributing 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. 

It is very important that the service performed matches accurately with the descripton in the CPT code. Therefore, for this very reason, it is important to remember that a code that is "close" to the procedure performed is not selected in lieu of an unlisted code. There are some who maintain that they are not allowed to use unlisted codes or that the use of the unlisted codes is undesirable. While the use of an unlisted procedure code does require a special report or documentation to describe the service, correct coding demands that you use a code that is appropriate for the service being provided (ie, a code that most accurately represents the services rendered and performed).


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