Anesthesia Coding Alert

Question: How should I bill radiofrequency for the S1, S2 and S3 nerves that innervate the sacroiliac joint?

Alabama Subscriber

Answer: Coders have varying opinions on your best option for sacroiliac (SI) joint nerve root injections. Some recommend 64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level) and +64623 (... lumbar or sacral, each additional level [list separately in addition to code for primary procedure]), but this isn't necessarily correct.

Here's why: The lateral branches of the sacral nerves innervate the posterior SI joint area. The paravertebral facet joint nerves, by contrast, are the medial (inside) branches that innervate the facet joint. The sacral area doesn't include facet joints because the sacrum is fused. Additionally, the medial branches of the sacral spinal nerves provide innervation to the central multifidus muscles rather than laterally to the SI joint. From this perspective, reporting 64622-64623 for radiofrequency destruction of the lateral branches is not compliant.

Better option: Other coders, however, look to 64640 (Destruction by neurolytic agent; other peripheral nerve or branch) to report radiofrequency (RF) destruction of the lateral branches of these sacral nerves. You would be compliant reporting a unit of service for each lateral branch RF destruction. In your example, you would report three units of 64640 for radiofrequency of the S1, S2 and S3 nerves.

Unlisted alternative: Some providers do not consider the spinal nerves/spinal nerve branches to fit the description of "peripheral." Those providers then look to 64999 (Unlisted procedure, nervous system) to report the RF destruction. You would only report one unit of 64999 because "unlisted procedure" codes do not have specific descriptions or associated RVUs. If you report 64999 for the RF destruction, look to the RVU for either codes 64622-64623 or code 64640 as your fee base.