Neurology & Pain Management Coding Alert

Question: How do we report radiofrequency ablation of ventral hernia incisional neuroma under IV sedation?
Ohio Subscriber

Answer: You report 64640 (Destruction by neurolytic agent; other peripheral nerve or branch) for a standard radiofrequency procedure. Whether you separately bill the sedation/block depends on the situation.

Option 1: If the provider performs the block during the same session as the thermal radiofrequency, you cannot separately bill the block. Coding guidelines consider the block to be the "anesthesia" for the radiofrequency ablation and part of the destructive procedure.

Option 2: Sometimes, however, the provider administers a diagnostic block to determine if the nerve or location is a source of the patient's pain. If he only administers the diagnostic block during that encounter and performs the ablation on another date, you can code both services. You would report 64425 (Injection, anesthetic agent; ilioinguinal, iliohypogastric) for the diagnostic block.