Anesthesia Coding Alert

Question: Our pain management specialist used pulse radiofrequency to treat a patient with suprascapular nerve pain. Since this procedure is new to our practice, is there anything we need to know before coding?

Florida Subscriber

Answer: For pulse radiofrequency of any anatomic region, any nerve, you should use 64999 (Unlisted procedure, nervous system), according to CPT Assistant from August 2005. This is reinforced in the CPT book with the guideline: "For therapies that are not destructive of the target nerve, (eg pulsed radiofrequency), use 64999."

Be proactive: Billing for pulse radiofrequency is similar to billing for any other unlisted procedure. You might first try to obtain a pre-authorization from the payer in a letter. If you have clinical trials that have been conducted by recognized bodies of physicians, make sure you include that information in your preauthorization letter requesting approval for a pain management procedure for which you will be using an unlisted code.

Pulse radiofrequency uses radio waves to intermittently affect the tissues around a painful nerve without nerve destruction. If your pain management specialist can explain why nerve destruction is not feasible and accurately document the patient's level of pain, it may help in obtaining pre-authorization.

Your letter also should include any current CPT codes that are similar in physician work, practice expense, and malpractice risk. Include in your letter a basic description of the procedure in layman's terms so that anybody who reads it can understand.

Finally, ensure the payer understands the anticipated cost of the care with and without that procedure. If the procedure will might minimize the risk of future, more expensive procedures, most payers will look favorably on that fact.