# RF ablation SI - My doctor plans on starting radiofrequency



## larkatin

My doctor plans on starting radiofrequency (not pulsed) ablation of the nerves that innervate the SI joints.  Would 64622 be appropriate (it does include sacral area)?  If so, would 64623 for any additional levels also be appropriate?  The sales rep suggests 64622 1st level and 64640 peripheral nerves for other levels.  I just don't feel comfortable with company recommendations - you know, they can provide copies of EOBs from different providers who get reimbursed mega bucks for some of these services!  But that doesn't mean the codes are correct!  Any input, and any links that you feel might help to substantiate the codes would be greatly appreciated.   I thought I read somewhere that SI RF is a miscellaneous code, but I may be mistaken.  We weren't doing these services, so I did not save the article.  Of course, my memory may not recall the info correctly, either - old age setting in and all!  Thanks and HAPPY NEW YEAR!


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## jdrueppel

Larkatin,
In my opinion I would code 64640 because the paravertebral facet joint nerves don’t innervate the SI joint. 

See previous thread regarding SI joint radiofrequency ablation on 10/15/08 titled Pain Management.  Do a Search and enter key word "radiofrequency" to find this thread.  It has a Pain Management Coding Alert reference.

Julie, CPC


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## larkatin

Thanks for the help!


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## marvelh

FYI: article for new / updated Pain Management LCD for National Government Services contractor directes covered providers to report SI nerve radiofrequency with 64999 as they consider it experimental / investigational


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## larkatin

Does this LCD affect all Medicare plans?  Please provide a link so I can provide this info for the doctor.  I  had a tough time convincing him 64622 wasn't right and I know I will have a tougher time presenting 64999 without some supporting documentation.  Thank you so much in advance.


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## mbort

Here is the link to the other thread that contains some really good information. 

https://www.aapc.com/memberarea/forums/showthread.php?t=9118&highlight=radiofrequency

64640 is the code that I use for these.


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## larkatin

I did review that post from the initial response to my query.  But Marvel is the pain goddess, so if she mentions something about 64999, I want to make sure that I shouldn't be using 64999 instead!


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## mbort

I respect that.  The one source that was in the previous post was from "the Coding Institute" which I believe is a credible source as well.


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## coder0908

Does anyone have a link to the LCD that Marvel mentioned?  

Thank-you,

Carmen


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## marvelh

The "64999" directive is only for those states that have National Goverment Services for their Medicare contractor, which I believe includes New York, Kentucky, Indiana and Connecticut.

Here is a link to the article: https://www.cms.hhs.gov/scripts/ctredirector.dll/.pdf?@_CPR0a0a043a07d1.JB_6YLD_2WnI 

If the link won't go thru the directive is in the Supplemental Instruction Article A48042 for the NGS Pain Management LCD: 
"...Use CPT code 64999 (Unlisted procedure, nervous system) for pulsed radiofrequency and the denervation procedures of the sacro-iliac joint/nerves. Pulsed radiofrequency for denervation is considered investigational and therefore, not medically necessary. Sacro-iliac joint/nerve denervation procedures are also considered investigational and not medically necessary..."

You can get the article through the NGS website under coverage and then active articles.

On a side note, I would strongly recommend reviewing the Q/A in the December 2009 CPT Assistant regarding coding for one technique of SI joint nerve RF destruction.  The answer is pretty well written and may provide the "written proof" that may help.  Depending upon the technique your provider is using, the 64640 code may be correct.  Unless of course this is a Medicare patient & your contractor is NGS!

Good luck & IF I could only convince my husband of the goddess concept!


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## jmistry

*cpts for si joint RF and Ablation for S1, S2, S3 of sacral nerve*

what cpt is appropriate to use for SI joint radiofrequency 

what cpt is appropriate to use for Ablation of individual each sacral nerve levels S1, S2, and S3


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