Neurology & Pain Management Coding Alert

Question: I’m trying to code for a case with the following documentation: “10 cm RK cannulae with 10 mm curved active tips were carefully advanced to the inferior aspects of the pedicles at T11, T12, and L1 and moved in the neural foamina at T11-T12, T12-L1 and L1-L2 at their superior aspects to approximate the dorsal root ganglion at T11, T12 and L1.” He completed radiofrequency neuroaugmentation, then the other procedures. He thinks we should code it at radiofrequency of the intercostal nerves (64620) x 3. Is this correct?

Pennsylvania Subscriber 

Answer: Anatomically, the dorsal root ganglion is located before the anterior and dorsal roots merge together to form the spinal nerve. The intercostal nerve is a branch of the spinal nerve after it exits the foraminal opening. The intercostal nerves are considered to be T1–T11. Numbers T12 and L1 are not considered to be intercostal nerves.

In addition, physicians typically perform radiofrequency of the dorsal root ganglion in a pulsed/non-thermal mode so as to not potentially thermally ablate motor fibers that are anatomically near the DRG. Pulsed radiofrequency of any nerve or nerve branch is reported with 64999 (Unlisted procedure, nervous system). That’s a more appropriate choice than your physician’s suggestion of 64620 (Destruction by neurolytic agent, intercostal nerve).