# RFA SI Joint



## themaid174@gmail.com (Aug 22, 2014)

Can someone please help me with the following: (Forgive me for mistakes I have to type this whole thing in)

Pt placed supine,Areas over both SI joints prepped and drapped. A point of maximum tenderness was found at each level and marked.

Over each side of maximum tenderness a total of 2mL of 1% lidocane was infused in the skin subctaneous tissue for analegesia. A specially designed radiofrequency needle, which was shielded except fo the 10-mm active tip was advanced toward the point of maximal tenderness. Once adequate depth was obtained and confirmed by pt, then sensorimotor testing was performed.Sensory testing showed a repeat of the patients pain at the levels noted on the below graph. The motor testing showed no untoward motor movements. Approximately 1 mL of 0.25% bupivacaine with 5 mg of Depo-Medrol were infused in this space.This was allowed to act approximately one minute before radiofrequency was performed. Radiofrequency ablation was then performed for a total of 2 minutes at 40 degrees at pulsed form. A second point of maximal tenderness was noted on the left side and this same procedure was performed at this level This procedure was repeated on the right with two points of maximal tenderness note in each SI joint. After the procedure was complete deep palpatation was performed at each level and no pain was elicited. Refer to the following levels:
R L5-S1
R S2
R S3 
L SI 
L S2
L S3

Can someone help me code this?  Thank you in advance


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## dwaldman (Aug 22, 2014)

. Radiofrequency ablation was then performed for a total of 2 minutes at 40 degrees at pulsed form

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Within the note it appears it describes pulsed radiofrequency

Below is guidance from the AMA CPT Assistant for pulsed radiofrequency procedures as unlisted code 64999

Question

What is the appropriate code to report for pulsed radiofrequency (PRF)? 

AMA Comment

Currently, there is not a specific CPT code that accurately describes PRF. Therefore, the unlisted code 64999, Unlisted procedure, nervous system, should be reported. It should also be noted that it is not appropriate to report Destruction by Neurolytic Agent codes 64600-64681 for PRF. 

AMA Comment

When reporting an unlisted code to describe a procedure or service, it will be necessary to submit supporting documentation (eg, procedure report) along with the claim to provide an adequate description of the nature; extent; need for the procedure; and the time, effort, and equipment necessary to provide the service.


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## themaid174@gmail.com (Aug 25, 2014)

Thank you, I so totally missed that. That would have made it much easier if I would of seen that, I think I just panicked when I saw the levels. Pain management is soo confusing to me.  I appreciate that you are always there to help. Thanks again!


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## themaid174@gmail.com (Aug 25, 2014)

Sorry  I should of asked, should I then report 64999 bilateral 3 times? Also do you know what I should compare it to?  Thank you!


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## dwaldman (Aug 25, 2014)

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. 
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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.


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## dwaldman (Aug 25, 2014)

Here is from April 2001 AMA CPT Assistant regarding no modifiers/1 unit for unlisted procedure:

Since unlisted codes do not include descriptor language that specifies the components of a particular service, these codes are reported without modifiers. Modifiers are used to indicate that a service or procedure performed was altered by some specific circumstance, but not changed in its definition or code. Since unlisted codes do not include descriptor language that specifies the components of a particular service, there is no need to "alter" the meaning of the code. 

When performing two or more procedures that require the use of the same unlisted code, the unlisted code used should only be reported once to identify the services provided. This is due to the fact that the unlisted code does not identify a specific unit value or service. Unit values are not assigned to unlisted codes since the codes do not identify usual procedural components or the effort/skill required for the service.


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## themaid174@gmail.com (Aug 26, 2014)

Thank you so much for your help!


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