Neurology & Pain Management Coding Alert

Patients that require interventional PM can present several coding hurdles. There are several different methods your specialist might employ to combat the pain, including

Remember, RFA = Rhizotomy

One method of interventional PM your provider might use is radiofrequency rhizotomy, also called radiofrequency ablation (RFA), confirms Amy C. Pritchett, BSHA, CPC, CPMA, CPCI-I, CRC, CANPC, CASCC, CEDC, CCS, CMDP, CMPM, CMRS, C-AHI, ICDCT-CM, ICDCT-PCS, past president of the American Academy of Professional Coders.

According to the University of California San Francisco RFA “is one of the newest pain control techniques. In this nonsurgical procedure, radiofrequency waves are delivered to certain nerves, with the goal of interrupting pain signals to the brain. RFA typically targets pain from the facet joints, which can contribute to chronic pain in the neck or lower back, and the sacroiliac joints, which can contribute to chronic low back pain.”

It’s appropriate that UCSF calls RFA one of the “newest” interventional PM techniques, as CPT^® gave it some brand new codes for 2020.

Here’s the RFA codes most used by Pritchett and Marilyn Torres, COC, CPC, CANPC, coding/billing supervisor at Meridian Medical Management in Belleville, New Jersey. (Codes new for 2020 are indicated with an *.)

• 64620 (Destruction by neurolytic agent, intercostal nerve)
• *64624 (Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed)
• *64625 (Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography))
• 64630 (Destruction by neurolytic agent; pudendal nerve)
• 64633 (Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint)
• +64634 (Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure))
• 64635 (Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint)
• +64636 (Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure))
• 64640 (Destruction by neurolytic agent; other peripheral nerve or branch).

Note 1: Due to the new RFA codes, some of the codes listed above do not appear sequentially in the CPT^® book. Check with payers on new codes as well, as they might have their own guidelines on reporting these newer codes. And, above all, make sure you pay attention to which RFA code you are choosing in the CPT^® book; when codes are out of sequence, it can put coders out of sorts.

Note 2: This is not intended to be a complete or approved list of RFA treatments for interventional PM. Always choose the CPT^® code that most closely represents the provider’s actions during the encounter.

Electrical Stimulation Puts Volts to Patient’s Pain

Another interventional PM technique many specialists use is electrical stimulation, which uses targeted electricity (via neurostimulator electrodes) to treat the patient’s pain. Electrical stimulation patients might require several different services during their PM treatments, including insertion and removal of electrodes; and removal, revision, and replacement of the neurostimulator.

According to Torres and Pritchett, they often use these codes for their providers’ electrical stimulation interventional PM treatments:

• 63650 (Percutaneous implantation of neurostimulator electrode array, epidural)
• 63655 (Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural)
• 63661 (Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed)
• 63622 (Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed)
• 63663 (Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed)
• 63664 (Revision including replacement, when performed, of spinal neurostimulator electrode plate/ paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed)
• 63685 (Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling)
• 63688 (Revision or removal of implanted spinal neurostimulator pulse generator or receiver).

Note: This is not intended to be a complete or approved list of electrical stimulation treatments for interventional PM. Always choose the CPT^® code that most closely represents the provider’s actions during the encounter.