# Pain Management - position to lesion



## KimberlyLanier (Oct 15, 2008)

Does anyone know how you would code a Radiofrequency Simplicity III electrode.

Done on the S1 S2 S3 and S4, states 3 contacts were in the appropriate position to lesion.  Lesioning was carried out using the Simplicity III Pre-program protocol at 85 degrees centigrade for 5 minutes.


Thanks 

Kimberly


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## tcraig (Oct 15, 2008)

The CPT is 64622, 64623 and we list the probe as L9900.


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## KimberlyLanier (Oct 16, 2008)

*Radiofrequency Simplicity III*

Craig thanks so much for the information, we was not sure as to the 64622 because there was an Anesthesia and Pain Management Coding Alert that went out about Pulse Radiofrequency have seen this article.  States to use Code 64999 states they use a probe to stun the nerves.

Please let me know.

Thanks
Kimberly


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## BFAITHFUL (Oct 20, 2008)

this should not be coded as 64622 but as cpt 64640 there is a CPT assistant out on this, I will locate if for you.  64622 is used for paravertebral/facet radiofrequency.  there are no facets/median branch below L5-S1.


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## KimberlyLanier (Oct 27, 2008)

Hi, Betsyrivera did you by chance find the CPT Assistant on this?

Thanks for you help Kim


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## mbort (Oct 27, 2008)

Facet Denervation vs Facet Joint Nerve Injection or Destruction Procedure(s)

If there is a favorable response to facet joint or facet joint nerve (ie, medial branch) injections, then more permanent techniques for the treatment of facet pain may be considered. In this instance, a destructive lesion of the medial branch nerve is performed, blocking the passage of painful messages from the affected facet joint to the rest of the central nervous system. The 64470-64476 series of codes should not be reported to describe denervation procedures.

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.


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## BFAITHFUL (Oct 28, 2008)

I do have some information on this, Im at work right now so I will post it later this afternoon.


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## BFAITHFUL (Oct 28, 2008)

This is from the "The Coding Institute"


Your first step toward correct coding is to verify
whether the physician performed the destruction within
the SI joint itself or to the nerves that innervate the SI
joint. Chances are, you&#146;ll be coding for procedures that
affect the surrounding nerves.
&#147;The injections often are performed on nerves that
derive from the lateral branches of the S1-S3 dorsal rami,&#148;
explains Myriam Nieves, CPC, ASC-PM, director of
coding and reimbursement for Axis Management and
Billing Services in Hollywood, Fla. &#147;Therefore, the
provider&#146;s documentation will most probably state that
&#145;Motor stimulation was performed at the SIJ medial
branch nerves.&#146;&#148;
Not so fast: Many coders rely on codes 64622
(Destruction by neurolytic agent, paravertebral facet joint
nerve; lumbar or sacral, single level) or 64623 (&#133; lumbar
or sacral, each additional level [List separately in
addition to code for primary procedure]) for these
injections, but that can be a mistake. Some basic
knowledge of anatomy helps to show why:
Reason 1: The paravertebral facet joint nerves don&#146;t
innervate the SI joint. Nieves believes that coders usually
get confused because the descriptors of 64622 and 64623
read &#147;lumbar or sacral.&#148; Coders who are not familiar with
anatomy might think this justifies an injection in the
sacroiliac joint.
Reason 2: There are no paravertebral facet joints
below the L5-S1 facet joint. Providers often perform
destruction of some branches that innervate the SI joint
(such as L5, S1, S2 and S3). These are not paravertebral
facet joint nerves, so coding it as such is incorrect.
Report RF More Accurately with 64640 or 64999
So, if 64622 and 64623 aren&#146;t accurate for reporting
RF of the nerves surrounding the SI joint, what&#146;s your best
option? Many coders tend to agree that you have two
viable alternatives, depending on the situation: 64640
(Destruction by neurolytic agent; other peripheral nerve
or branch) or an unlisted code, such as 64999 (Unlisted
procedure, nervous system).


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## KimberlyLanier (Oct 29, 2008)

*Thanks*

Betsyrivera,

Thank you very much.


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## KimberlyLanier (Oct 29, 2008)

*Coding 64400*

Betsyrivera,

I am new to Pain Management Coding, but could you tell me if when a Pain Dr. does a Trigeminal nerve block and says he does 3 at the Facial nerve,Supraorbital nerve, and Supratrochlear, can you code 64400 three times.

He is also doing Nerve Ablation the same way asking to code it three times with Code 64600.

Is this correct or can you only code one time if they are all branches of the Trigeminal Nerve.

Thanks for you help.

Kimberly


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## myadav (Dec 29, 2008)

*Coding 64400 - physician anesthetizes*

Hi ,Kimberly


The physician anesthetizes a branch of the trigeminal nerve in 64400, the facial nerve in 64402, or the greater occipital nerve in 64405. The trigeminal nerve supplies sensory and motor fibers to the face, and is usually blocked superficially. The facial nerve supplies motor fibers to the muscles of facial expression. The greater occipital nerve supplies sensory fibers to the scalp. The physician draws a local anesthetic into a syringe and injects it into the branch of the nerve to be anesthetized.

Hope this will help you.

Myadav, CPC


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## myadav (Dec 29, 2008)

*Coding 64400*

hi

The physician destroys a portion of the trigeminal nerve to block pain or motor control to the face or scalp. Destruction is accomplished by injecting the nerve with alcohol or phenol. In 64600, a supraorbital, infraorbital, mental, or inferior alveolar branch of the trigeminal nerve is destroyed. In 64605, the second and third division branches at the foramen ovale are destroyed. Report 64610 if the second and third division branches at the foramen ovale are destroyed under radiologic monitoring.

MYadav, CPC


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## HCCCoder (Jan 9, 2009)

Hello all, 
I have a question regarding CPT codes 64622 and +64623.
This is what this certain documentation reflect: "Radiofrequency rhizotomy of the right lumbar medial branch nerves at L2, L3, L4, L5, and S1, needle localization. 
How would you code this?
Thank you in advance,
Lilit


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## mbort (Jan 9, 2009)

Lilit,
those are the correct codes, I actually responded under another forum heading with those codes for you.

Mary, CPC,CPC-ORTHO


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## HCCCoder (Jan 9, 2009)

Hello all, I am having such a hard time with these codes. 
Can someone break down this for me? 
When documentation states "bilateral cervical facet medial nerve blocks at C3, C4, C5, C6, and C7 (Please note, these are separated by commas) levels," is the coding of this kind of documentation any different than if it was documented as "C3-C4, C4-C5, C5-C6, C6-C7 ((Please note, these are separated by dashes), ?????  
Would you code this scenario as 
64470-50 C3-C4
64472-50 C4-C5
64472-50 C5-C6
64472-50 C5-C7

Would you code the same way if it was C3, C4, C5, C6, C7 as supposed to 
C3-C4, C4-C5, C5-C6, C6-C7 

My question might be silly, but I need someones help. 

Thanks in advance,
Lilit


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## vruzic (Mar 10, 2009)

*using mod 50*

how would you code :
1-64622
2-64623 times3
3-77003  with mod.50


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## mbort (Mar 10, 2009)

77003 is only codable one time per spinal region.  It is not eligible for the 50 modifier


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