# RFA of C2 branch of occipital nerve



## karras (Jul 24, 2012)

Does anyone know how to code an RFA of the C2 branch of the occipital nerve?  I'm stumped.  Any help would be greatly appreciated.  Thanks!


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## dwaldman (Jul 24, 2012)

"It would not be appropriate to report code 64640 Destruction by neurolytic agent, paravertebral facet joint nerve; other peripheral nerve or branch. The third occipital nerve is the medial branch of C2-3 and its location is similar anatomically with performing a paravertebral facet joint injection. However, the difference is that the location of the third occipital nerve may vary, so the physician may need to burn over a wider area to ensure capturing the third occipital nerve in the procedure."

Above is part of CPT Network response I received, stating that the third occipital nerve would be include in the reporting of the C2-3 level under 64633 when other medial branches are already being blocked at this level. I was not sure if this is the same thing you are referring to, on wikipedia they also refer to the third occipital nerve as 

"While under the Trapezius, the medial branch of the posterior division of the third cervical nerve gives off a branch called the third occipital nerve (also known as the least occipital nerve)"

I also saw the below post when doing a search on this forum describing the treatment of the lesser occpital nerve with 64450 which would crosswalk to RFA code 64640 if non pulsed. 

https://www.aapc.com/memberarea/forums/showthread.php?t=14173


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## karras (Jul 25, 2012)

Thanks.  I appreciate the info.


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## Barb Tucker (Sep 13, 2012)

We bill 64490 for our Third Occipital Nerve procedures


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## dwaldman (Sep 18, 2012)

If you are reporting per facet joint, and you are treating the C2-C3 level and you are already reporting 64633, my understanding is you would not additional report 64640 for the treatment of the 3rd occiptial nerve, this work would be inclusive in the C2-C3 level represented by 64633


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