# RFL procedure question



## atheri992 (Jun 12, 2014)

My question is how you would code this? I am good with the modifiers, etc so just the CPT codes are my issue. RFL's tend to trip me up sometimes more than anything else. 

Would it be 64635 X1 and 64636 X3? The doc put in 64635 X1, 64636 X1, and 64640 X3 as what he thought it was.  Are your sacral nerves considered peripheral? 


This is the procedure note:

Radiofrequency lesioning SIJ , Level RIGHT-sided L4-S3.
Patient was greeted pre-procedure, questions answered and chart reviewed. Consent obtained, vitals were taken, were stable and were charted by nursing staff and the time out was completed prior to procedure, RN present. Cap and Masks were worn by staff in the room. Standard monitors were applied. The patient was placed in the prone position. The right lumbar area was prepped with Chlorhexadine and draped in sterile fashion. The skin over the target for each medial branch nerve was anesthetized with 0.5% lidocaine. A 10/18/10 radiofrequency needle was advanced to each target site under fluoroscopic guidance. No paresthesias were elicited with needle placement and aspiration was negative for heme and CSF. 
L4: Impedance 385, Sensory felt at .13 without sensation down the leg; Impedance, 385, Motor felt at 1.5 without sensation down the leg to 3.0.
L5: Impedance 302, Sensory felt at .60 without sensation down the leg; Impedance, 302, Motor felt at 1.39 without sensation down the leg to 3.00.
Each site was injected with 0.5 ml 2% preservative-free lidocaine and triamcinolone 20mg for L4 and L5; 2% lidocaine only for S1-3.
Radiofrequency lesioning was performed for 90 seconds set at 80 deg Celcius. Each site was then injected with 1 ml 0.5% preservative-free Lidocaine as the needle was removed, skin cleansed and a sterile bandage was applied. The patient tolerated the procedure well and no complications were encountered. Following the procedure the patient's vital signs were stable. The patient was discharged home in good condition with post-procedural instructions. EBL <1cc 


Thank you for any advice!!
Angela


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## dwaldman (Jun 13, 2014)

For the S1-S3 portion I agree with 64640 x 3

For the L4, L5, since this appears for treatment of lateral branch nerves innervating the SI joint so 6463X codes would not be appropriate because those codes represent services are for medial branch nerves that innervate the facet joints. 

There are specific medical policies regarding the coverage of sacroiliac joint denervation and this type of procedure is not reported under codes for treatment of a different purpose (facets)

This response is based on assuming the L4 L5 treatment is for the lateral branches innervating the SI joint.


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