# RFA of Right UpperExtremity Stupm Dyesthetic Nerve



## joanne71178 (Mar 1, 2013)

Does anyone have extrenice with coding this procedure?  

Procedure:
Right Upper Extremity stumkp Dysesthetic Nerve Radiofrequency Ablation of four target locations; 
Procedure was performed with Hyaluronidase 150units/mL

Diagnosis:
Neuroma of amputation stump (997.61), Late effect of traumatic amputation (905.9), Peripheral Nerve Injury, upper limb (955.9)

Following appropriate time for anesthetic effect, a A 20g 60 mm Sharp Tip Baylis BMC Curved Needle with a 10mm Active Tip was advanced incrementally under fluoroscopic guidance into the target zones of the Right Upper Extremity Stump.  Follwing the proper localization, Sensory Stimulation was perfomed at no greater than 0.5 volts to ensure proper placement. 

The same technique was utilized at one other Anterior site, as well as two posterior sites. 

A mixture containing  a concentration of 2mLs of 2% Preservative Free LIdocaine and 1 MlLs of Hyaluronidase 150 units /mL was drawn.  A total of 3 mLs ws injected approximately equally among the injection sites. 

Standard lesioning was carried out at 0 degrees Celsius for 90 seconds.  Each level was lesioned a total of 3 times at each site.  


Any thoughts?  I was considering 64640.  But it could also be 64999.  If it is 64640 would I only code 1 unit?  or would it be the number of sites(location)? 

Thanks in advance.


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## dwaldman (Mar 1, 2013)

https://www.aapc.com/memberarea/forums/showthread.php?t=16475

In above link, the below portion of a response from the AMA CPT Network was provided. It sounded like they support reporting 64640 for non-pulsed  radiofrequency ablation of a neuroma. I potentially would only report 64640 one time for the information you provided. 


Please be advised that your inquiry was forwarded to our CPT Advisor representing the American Academy of Pain Medicine for review. Based solely upon the information provided in your electronic inquiry, from a CPT coding perspective and per our CPT Advisor, ?It would be appropriate to report a nerve block injection code for the anatomic site involved or a destruction code if neurolysis is the goal. Most specifically, CPT codes 64450, Injection, anesthetic agent; other peripheral nerve or branch, or 64640, Destruction bby neurolytic agent; other peripheral nerve or branch, for this injection(s), since these codes respectively address the additional work of an injection of an anesthetic agent (nerve block), neurolytic or sclerosing agent into the peripheral nerves


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