Anesthesia Coding Alert

Hint:  Location is key when determining correct codes

"Performed radiofrequency (RF) to the patient's sacroiliac joint" on a patient's chart may sound like solid documentation, but when you encounter this phrase on your next chart, be sure to check these important missing details before you begin coding. Verify If the Physician Treats the SI Joint or Nerves Your first step toward correct coding is to verify whether the physician performed the destruction within the SI joint itself or to the nerves that innervate the SI joint. Chances are, you'll be coding for procedures that affect the surrounding nerves.
 
"The injections often are performed on nerves that derive from the lateral branches of the S1-S3 dorsal rami," explains Myriam Nieves, CPC, ASC-PM, director of coding and reimbursement for Axis Management and Billing Services in Hollywood, Fla. "Therefore, the provider's documentation will most probably state that 'Motor stimulation was performed at the SIJ medial branch nerves.'"

Many coders rely on codes 64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level) or CPT 64623 (... lumbar or sacral, each additional level [List separately in addition to code for primary procedure]) for these injections, but that can be a mistake. Some basic knowledge of anatomy helps to show why:

Reason 1: The paravertebral facet joint nerves don't innervate the SI joint. Nieves believes that coders usually get confused because the descriptors of 64622 and 64623 read "lumbar or sacral." Coders who are not familiar with anatomy might think this justifies an injection in the sacroiliac joint.

Reason 2: There are no paravertebral facet joints below the L5-S1 facet joint. Providers often perform destruction of some branches that innervate the SI joint (such as L5, S1, S2 and S3). These are not paravertebral facet joint nerves, so coding it as such is incorrect. Report RF More Accurately with 64640 or 64999  So, if 64622 and 64623 aren't accurate for reporting RF of the nerves surrounding the SI joint, what's your best option? Many coders tend to agree that you have two viable alternatives, depending on the situation: 64640 (Destruction by neurolytic agent; other peripheral nerve or branch) or an unlisted code, such as 64999 (Unlisted procedure, nervous system).

"I believe that 64640 could be a good choice for injecting the nerves around the SI joint," Nieves says. "Technically, a peripheral nerve is a nerve located outside of the brain and spinal cord, so it would be correct to classify these nerves as 'peripheral' nerves or branches."

Some providers are not comfortable reporting 64640, either due to the description (they want something more specific) or due to the RVU valuation. They choose to use 64999 (Unlisted procedure, nervous system) instead.

Each option has its [...]