# Need Coding help for RF @ S1 & S2



## dyoungberg (Apr 11, 2012)

This procedure was done 10/12/2011.  Can anyone tell me what the correct coding would be for this please?

PROCEDURE:   
1. RADIOFREQUENCY FOR S1 AND S2 MEDIAL BRANCH ON THE RIGHT SIDE 
2. FLUOROSCOPY 

PREOP DIAGNOSIS:   SACROILIITIS 

POSTOP DIAGNOSIS:	 SAME 

ANESTHESIA:		 MAC AVL minimum

COMPLICATIONS:	 NONE 

PRIOR ANTIBIOTIC:  NONE 

PROCEDURE IN DETAIL: After obtaining consent, patient was moved to the fluoro suite where the patient was placed on the fluoro table in the prone position. Pressure points were checked and the back area was prepped with iodine and draped in a sterile fashion. By using PA and lateral fluoroscopy, and insuring the needle was not deep in the foramina, the target point of S1 and S2 was identified on the right. Target area was identified and skin was infiltrated with Xylocaine 1% using 25G needle.  

From this point we advanced 22G needle 3 ½ inches 10 mm active step from the skin towards the target point. We slide the tip of the needle against the target point. Sensory and motor simulation was done and reproduced the patient's pain to less than 0.5 millivolt. Motor stimulation was negative for any movement in the lower extremities. No muscle contraction was identified with motor stimulation. Heat lesioning was done at this level with 80temperature for 60 seconds. After the lesioning was done, a mixture of 1 cc Decadron (4 mg/ml) and 4 cc normal saline was instilled, and the needle was removed.
The patient tolerated the procedure very well.  

The patient was moved to the recovery room where the patient was observed in stable condition before being discharged home.  There was no weakness in the lower extremities and the patient moved all extremities freely.  


Thanks very much!


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## dwaldman (Apr 11, 2012)

In the below link they describe SI Joint primary innervation coming from the lateral branches of S1-S3 

http://www.painmedicinenews.com/download/RFAblationSacro_pmn0610_WM.pdf

Below is from AMA CPT Assistant where they describe lateral branch ablation as separate individual treatments being reported with 64640

"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 contri-buting 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). "

"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."


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