# Radiofrequency coding



## larkatin (May 13, 2008)

I have a doctor who recently started doing radiofrequency. Please explain how to code the following: 

Under fluoroscopic guidance, the junction between the right SI superior articular process and the right sacral ala was identified. The skin and subcutaneous tissue were anesthetized. 

Using a 3 1/2 inch, #22 gauge radiofrequency cannula, the bony landmark was identified and inserted until the tip touched the bone to the above-mentioned landmark. Cannula placement was confirmed on both anterior/posterior and lateral views. Local anesthesia was infiltrated at the 2 o'clock and 4 o'clock positions at the S1, S2, and S3 foramen on the right side. The cannula tips were placed under fluoroscopic guidance at the above-mentioned locations. Again, cannula placement was confirmed on both anterior/posterior and lateral views. Sensory stimulation was then performed at 50 hertz with reproduction of the patient's pain at less than 0.5 volts at each location. Motor stimulation was performed at 2 hertz up to approximately 2.5 volts with no abnormal right-sided lower extremity motor activity. 

An injection was performed through each cannula consisting of 1 ml of 2% lidocaine with 10 mg of Depo-Medrol. A radiofrequency electrode was then inserted through each of the cannula. Lesioning was performed at 80 degrees Celsius for 90 seconds at each level. Electrode and cannulas were removed intact. 

The patient was discharged to the post anesthesia area in satisfactory condition. 

My doctor chose 64622, 64623 x6 and 77003-26.  I am confused about the number.   Many thanks!


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## mbort (May 15, 2008)

I agree with you the numbers dont match up..I see 6 ...2 o'clock and 4 oclock positions at 3 different levels = 6  ...not sure where he is coming up with the 7th one unless he is trying to capture the initial cannula insertion at the SI, but I dont see that he did the radiofrequency at that level.


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## larkatin (May 15, 2008)

Thank you - that is what I saw also - I will review your reply with him.


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## med-biller (May 24, 2008)

I only get a total of 3 (64622, 64623 x 2, 77003-26).  He only placed needles at the S1, S2 and S3 on the right.  You would have 6 if it was a bilateral procedure.


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## smcbroom (Jun 3, 2008)

i agree with the previous response.  There were only 3 levels.  He only stated that he placed local anesthetic at the 2 & 4 o'clock positions but then did the radiofrequency at the S1,S2 and S3 foramen.  I would speak with your doctor again.


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## mbort (Jun 4, 2008)

surgeon indicates that he did the radiofrequency at all locations 2'oclock and 4'oclock


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## med-biller (Jun 15, 2008)

"Local anesthesia was infiltrated at the 2 o'clock and 4 o'clock positions at the S1, S2, and S3 foramen on the right side. "


I still only get 3 levels with the way it reads.


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