Neurosurgery Coding Alert

Question: I recently received a procedure note outlining "RFTC for nerve destruction." I am unfamiliar with this procedure. What is it, and how should I code for it?

California Subscriber

Answer: RFTC is an abbreviation for "radiofrequency thermal coagulation," which is also known as rhizotomy or medial branch neurotomy. This technique involves creating a lesion or burn in the medial branch of the posterior primary ramus nerve to treat facet joint pain, and thus improve function and patient comfort.Typically, the patient will undergo facet joint injections prior to receiving RFTC to pinpoint the facet joints as the true locus of pain.

If the physician uses RFTC in the lumbar or sacral area, you should report 64622 (Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level).

If the physician treats additional lumbosacral levels during the same session, report +64623 (... lumbar or sacral, each additional level [List separately in addition to code for primary procedure]) once for each additional level without any modifiers appended.

The term "agent" in the descriptor for 64622-64623 can include chemical, thermal, electrical and radiofrequency methods, according to the March 2002 CPT Assistant.