Neurology & Pain Management Coding Alert

Question: How do we code radiofrequency lesioning of the greater occipital nerve?

Minnesota Subscriber

Answer: Review your physician's procedure documentation, because the correct choice depends on the mode of radiofrequency (RF) used to create the nerve lesion(s).

When she uses continuous RF to destroy the greater occipital nerve, report 64640 (Destruction by neurolytic agent; other peripheral nerve or branch). If she uses pulsed RF, however, CPT® directs you to 64999 (Unlisted procedure, nervous system).

Explanation: Continuous (a.k.a. standard or thermal) RF therapy uses continuous radio wave energy to heat up nerve tissue to a point that it creates a destruction of the target nerve. This neurolytic lesioning decreases the patient's pain by interrupting the sensory nerve pathways.

In contrast, pulsed RF therapy uses shorter intermittent bursts of radio wave energy at much lower temperatures. Pulsed RF is not considered to be destructive; the technique "stuns" the target nerve tissue to prevents it from transmitting pain signals rather than directly damaging the target nerve tissue.

Heads up: Some payers now look at the provider's documentation for the temperature associated with the RF. For example, United Healthcare's coverage policy for Ablative Treatment for Spinal pain includes the requirements of "temperature 60 degrees Celsius or more and duration of ablation 40-90 seconds." Providers who include this type of information in their documentation make accurate coding easier.