Wiki 64635 and 64640

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Henson65

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Hello all,
I am new to the spine coding and have the below op report that the provider is saying to code as 64635, 64636, 64640, 64640 (of course with appropriate LT and 59 modifiers:

The skin and subcutaneous tissues were anesthetized with 1% lidocaine. Under direct fluoroscopic guidance, a 20-gauge radiofrequency needle with a 10 mm active tip was directed to contact the interface of the superior articulation process and transverse process at left L5. A second 20-gauge radiofrequency needle with a 10 mm active tip was directed to contact the interface of the sacral ala and superior articulating process of left S1. Needle positions were optimized in multiple fluoroscopic views. Motor stimulation of 2 Hz was then conducted with absence of anterior myotomal contraction at each level. Each nerve was then anesthetized with 0.25% bupivacaine preservative free. Radiofrequency lesioning was then performed maintaining a temperature of 85 degrees Centigrade for 90 seconds at each nerve. Additional 20-gauge radiofrequency needles with a 10 mm active tip were directed along the lateral margins of S1, S2 and S3 neuroforamen. Motor stimulation of 2 Hz was then conducted with absence of anterior myotomal contraction. Each nerve was then anesthetized with 0.25% bupivacaine. Bipolar radiofrequency strip lesions were then created along the lateral margins of left S1, S2 and S3 neuroforamen, maintaining a temperature of 85 degrees Centigrade for 90 seconds at each site.

I would code this as 64635, 64640, 64640, 64640 with appropriate LT and 59 modifiers....am I confusion levels and assigning 64640 when it should be 64636?
64635=L5
64640=S1
64640=S2
64640=S3
What area is the provider referring to with the assignment of 64636? Thanks in advance for any help on clearing up the confusion on this one.
 
Hello,
Per chapter specific guidelines Report 64633, 64634, 64635, 64636 per joint, not per nerve. Although two nerves innervate each facet joint, only one code may be reported for each joint denervated, regardless of the number of nerves treated. Use 64634 or 64636 to report each additional facet joint at a different vertebral level in the same spinal region.
Code 64636 is to capture the destruction of the nerve at the superior articulating process (facet joint) of the S1.
64640 x 2 would be for S2 and S3.
Hope this helps.
 
kathrynw said:
Hello,
Per chapter specific guidelines Report 64633, 64634, 64635, 64636 per joint, not per nerve. Although two nerves innervate each facet joint, only one code may be reported for each joint denervated, regardless of the number of nerves treated. Use 64634 or 64636 to report each additional facet joint at a different vertebral level in the same spinal region.
Code 64636 is to capture the destruction of the nerve at the superior articulating process (facet joint) of the S1.
64640 x 2 would be for S2 and S3.
Hope this helps.
Click to expand...
Thank you Kathryn, I appreciate your description!!
 
Hello,

Our physician performed a SACROILIAC RADIOFREQUENCY NEUROABLATION. He states he performed this at the below levels.
Are we able to bill for all levels?





At the right side, a 16 G insulated introducer needle with a 10 mm active tip was advanced to the probable location of the superior lateral branch of the S1 dorsal median nerve.

Proper needle position was confirmed with AP, oblique and/or lateral fluoroscopic imaging.

Subsequently, 1 cc of local anesthetic was injected.

Then lesioning occurred at 80 degrees Celsius for 90 seconds.

These steps were then repeated in a similar manner at the following nerves:

Lateral branch of the S1 dorsal median nerve

Inferior branch of the S1 dorsal median nerve

Superior branch of the S2 dorsal median nerve

Lateral branch of the S2 dorsal median nerve

Inferior branch of the S2 dorsal median nerve

Superior branch of the S3 dorsal median nerve

Lateral branch of the S3 dorsal median nerve

Inferior branch of the S3 dorsal median nerve

In total 9 peripheral nerve branches to the SI joint was lesioned on the right. The procedure was repeated in a similar manner on the left.

Any assistance would be helpful.
Thank you,
Susan
 
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