Neurology & Pain Management Coding Alert

Question: What is the difference between standard and pulsed radiofrequency, and how should I  code for each?


Tennessee Subscriber


Answer: Both standard and pulsed radiofrequency (RF)--also known as ablation or lesioning--are typically considered destructive nerve procedures. Standard RF is a continuous process that uses a high temperature (60-80 degrees centigrade) for 60-90 seconds. Pulsed RF, just as the name suggests, is made up of intermittent pulses of RF with a much lower temperature (3-5 degrees centigrade over body temperature, often in the range of 38-42 degrees centigrade) for up to several minutes. 

When coding for standard RF, you should look under the -Destruction by Neurolytic Agent- category of CPT (64600-64681). Then choose the appropriate code according to the anatomic location of the RF procedure.

Pulsed equals unlisted: CPT Assistant clarified in its August 2005 issue that any pulsed RF procedure should be coded as 64999 (Unlisted procedure, nervous system).
 
Beware bundles: Any injections performed at the same time of the RF destruction procedure are included in the destruction code. Example: It is fairly common for a provider to inject anesthetic and/or steroid to decrease the patient -discomfort- associated with the RF procedure and initial -neuritis- (nerve response). In this case, you would only report the proper RF code.