# splanchnic sympathetic neurolysis via cryoablation/



## jessicahocker (Nov 5, 2015)

What is the correct CPT code for a Splanchnic Sympathetic Neurolysis via Cryoablation?  This was done for abdominal sympathetic pain.

Procedure Details: 
Position: prone
Local anesthetic: buffered "no sting" lidocaine 0.25% in skin
Needle used: 25ga 6in
Location: right T12 at inferior/anterior margin of vertebral body
angiocath advanced to inferior/anterrior margin in a sharp caudad to cephalad fashion
cryo probe advanced through catheter; four freeze cycles then carried out with slight repositioning between each for two minutes with thaw cycle in between
Contrast: omnipaque 3cc, (total 3cc with waste), no apparent vascular runoff
Injectate: in 2-3 cc increments after negative aspiration, bupivacaine 0.25% 20cc
Dye displaced after injection of local anesthetic
Needle removed
Returned to post-op area ambulating 

Our practice is doing these fairly often recently, and I'm at a loss since there doesn't seem to be a lot of information on this procedure online.  ANY help would be much appreciated!!  Sources would be even better  THANK YOU in advance.


----------



## dwaldman (Nov 7, 2015)

Part of a private response I received from the AMA CPT Network,

"Based solely upon the information provided in your electronic inquiry, from a CPT coding perspective, there is no specific CPT code to describe "left radiofrequency lesioning of the lumbar sympathetic chain'". Therefore, code 64999, Unlisted procedure, nervous system, should be reported once even though the radiofrequency ablation was performed at more than one spinal level......."

Below is from AMA CPT Assistant that describes treatment with phenol of the splanchnic nerve with CPT 64680. The other thing to consider is does the carrier cover cyroablation as the form of nerve destruction.

AMA CPT Assistant 1999
Surgery Nervous System, 64680 (Q&A) 

Question

How do I report a procedure where the splanchnic nerve is injected with phenol? 

AMA Comment

Since the splanchnic nerve is part of the celiac plexus, and phenol is a neurolytic agent, you should report CPT code 64680, Destruction by neurolytic agent, celiac plexus, with or without radiologic monitoring.


----------

