# Radiofrequency denervation



## ortho1991 (Jun 29, 2009)

Hi All

I hope someone can help me. I am billing for the doctor, the insurance is medicare.  Here is the op-note.

DX:  Lumbar facet syndrome.

OP:  Radiofrequency denervation of bilateral L3-L5, L5-S1 facets (bilateral L3,L4, "L5" medial branches); fluoroscopic needle localization.

The patient was brought to the operating room and placed in th prone position.  The skin was prepped with iodine scrub and wash.  With intermittent fluoroscopy to minimize the dose of radiation, a 22-gauge SMK needle was advanced to the junction of the superior aspect  of the L4 transverse process and the lateral aspect of the superior articulating process at the same level.  The needle was walked over the transverse process and advanced 2-3 mm to lie along the path the corresponding medial branch nerve.  AP and lateral images were obtained to verify proper needle position.  Sensory and motor stimulation were then performed, which elicited deep local back discomfort, but no evidence of motor stimulation in the gluteal muscles of extremities.  A tandem needle insertion was performed adjacent to the SMK neekle to supply local anesthesia to the tissues around the tip of the SMK needle.  Subsequently, a medial branch nerve denervation was performed for 90 seconds at 80 degees Celsius without complication.  The radiofrequency probe was removed with the neekle left in place and a mixture of Kenalog and lidocaine was instilled through the needle.  The needle was removed.

This procedure was done for the bilateral L3,L4, "L5" medial branches.

We billed 64622 2 units
             64623 2 units
             64475 1 unit
             64476 1 unit
             77003 26

Medicare only paid us for 64622 64623 stating 64475-64476 bundled, is this right or our we missing something , is medicare the only carrier that bundles this.  Any help will be appreciated

Thank you Cathy


----------



## FractalMind (Jul 2, 2009)

according to your report the doctor is using RF Denervation for all levels, you code per nerve root meaning L3-L5=2 nerve roots, two levels, L5-S1=2 nerve roots, two levels; all four bilateral, so the correct coding should be:

L3-L5, L5-S1 facets (bilateral L3,L4, "L5" medial branches)

64622-50 1 unit
64623-50x3 units
77003-26


----------

