# RFA of Sacroiliac Joint



## celcano (Jan 14, 2015)

I have a question of the best way to bill for the RFA of the sacroiliac joint.  A CPT Assist article advises to bill 64640, 64640-59, 64640-59 and 64640-59.  Other coders just bill 64640 X 4.  

Any advice.

Also, if you are billing with the 59 modifier, would we now use one of the new "X" modifiers for 59.  If so, which one?

Thank you!


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## dwaldman (Jan 14, 2015)

This could be per the payer ability to process the procedure if they can process quantity versus single lines. And if they have coverage for the procedure

Some carriers might reserve modifier 59 for only used with codes that a NCCI code edit.
WPS Medicare J5 (although they do not cover SI Joint nerve denervation) is one of the those carriers that only accept modifier 59 for NCCI edit code pairs. They additionally have this policy for new modifier XS

http://www.wpsmedicare.com/j5macpartb/resources/modifiers/modifier-xs.shtml


Modifier XS Fact Sheet
Definition
Separate Structure, A Service That Is Distinct Because It Was Performed on A Separate Organ/Structure

Appropriate Usage
Coding pairs are part of the National Correct Coding Initiative (NCCI) procedure to procedure edits 
Documentation indicates the services were provided on different organs/structures 
Use Modifier XS with the Column 2 procedure code in the NCCI files 
Use Modifier XS only when there is no other modifier to describe the situation 

Inappropriate Usage
Code pairs are not part of the NCCI procedure to procedure edits


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## Melissa Harris CPC (Jan 15, 2015)

In the case of the si joint RF, would the XS modifier be appropriate?  is it a separate structure each level?   I am confused.

Melissa


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## dwaldman (Jan 17, 2015)

http://www.aap.org/en-us/profession.../Payer-Implementation-of-HCPCS-Modifiers.aspx

At this link you can click on UHC's guidance on these modifiers in their January bulletin.

I would check with your Medicare carrier that you bill to see if they are looking at these modifiers such XS to be used only with NCCI code pairs or to describe additional levels or if they just want it quantity bill for a unilateral procedure at multiple separate sites.


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## BeckyGK (Mar 31, 2015)

Since 64640 is for other peripheral nerve or branch unless a nerve is specified you cannot use this code.  Since it is specifying Sacroiliac Joint RFA that is an unspecified code 64999.  A joint is not a nerve.


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## Melissa Harris CPC (Apr 1, 2015)

64999 is for the pulsed radiofrequency of the sacroiliac joint.   You would use the 64640 for non pulsed.  

From AMA CPT Assistant, ablation of the sacroiliac joint is an unlisted code per the June 2014 article. For individual nerve destruction that is non-pulsed, it is recommended by June 2012 CPT Assistant to use 64640.

For the reporting the unlisted procedure, you would report 64999 with no modifier with one unit of service. You could base the comparison code/cost on 64640 and number of sides/levels since would be an accurate capture of similar resources.


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. 
__________________________________________________ __

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. 

Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management


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## dwaldman (Apr 1, 2015)

Melissa, isn't the SI joint ablation unlisted for non-pulsed for the joint itself?


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## COMPauditor (Apr 10, 2015)

*Still confused*

So for a sacral rhizotomy, according to the AMA response, the best code to report this would be 64999?


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