Neurology & Pain Management Coding Alert

Question: Our physician injected multiple branches of the genicular nerve (superior lateral, superior medial, and inferior medial). Do we report 64450 once, or bill it three times with modifier 51? Also, what would be the correct code for thermal radiofrequency ablation of this nerve? 

Delaware Subscriber

Answer: If the provider specifically documents in the record that he has performed injections in different branches, you can use multiple units of code 64450 (Injection, anesthetic agent; other peripheral nerve or branch) with modifier 51 (Multiple procedures). 

Anatomy lesson: The knee joint is innervated by the articular branches of various nerves, including the femoral, common peroneal, saphenous, tibial, and obturator nerves. These branches around the knee joint are known as genicular nerves. 

Since the genicular nerve branches are considered to be somatic nerves, if the physician performed thermal radiofrequency ablation (RFA), you would bill 64640 (Destruction by neurolytic agent; other peripheral nerve or branch). This code, similar to the 64450 injection code, is based on each individual nerve or nerve branch and as such it would be billed with 3 units of service if the physician ablated all three individual nerve branches.