Anesthesia Coding Alert

Question: We report 64640 for radiofrequency ablation (RFA) of the sacroiliac (SI) joint. When the physician treats the lateral branches of the S1-S4 nerves, we either submit 64640 x 4 units or list each 64640 on a separate line, depending on the payer. Medicare is denying the claims based on the daily frequency or units. How should we handle this? Rhode Island Subscriber Answer: The carrier might deny your claim because, although 64640 (Destruction by neurolytic agent; other peripheral nerve or branch) is the best code choice for radiofrequency ablation of the nerves providing sensory innervation to the posterior SI joint, billing it four times within a session might be considered unusual. Try this: Indicate the individual nerves destroyed (such as "S1, S2, S3, and S4 lateral branches") in Box 19 (or the electronic equivalent). If Medicare denies a claim you'll need to go through the appeals process, including sending [...]