You Be The Coder:
RFA of SI Nerve Branches
Published on Sun Sep 09, 2007
Question: How should I bill for radiofrequency of the sacroiliac (SI) nerve branches?
Georgia Subscriber
Answer: Coders and physicians debate about which specific nerve(s) innervates (or communicates with) the SI joint -- which means they also debate about how to code the destruction procedures.
Physicians can treat several different nerves to the SI joint, so carefully review your physician's documentation of the procedure -- and which nerve(s) he destroyed -- before coding.
Example: Your pain specialist might destroy the L4 and L5 paravertebral facet joint nerves, which you would code with 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]). Your physician might also access the lateral branches of S1 and S2 via the sacral foramen, which you would report with 64640 (Destruction by neurolytic agent; other peripheral nerve or branch).
If your physician inserts the radiofrequency probe into the SI joint and performs multiple radiofrequency destructions within the joint itself, CPT does not currently have a specific code for this technique. You should report 64999 (Unlisted procedure, nervous system) instead.
