64999 is for the pulsed radiofrequency of the sacroiliac joint. You would use the 64640 for non pulsed.
From AMA CPT Assistant, ablation of the sacroiliac joint is an unlisted code per the June 2014 article. For individual nerve destruction that is non-pulsed, it is recommended by June 2012 CPT Assistant to use 64640.
For the reporting the unlisted procedure, you would report 64999 with no modifier with one unit of service. You could base the comparison code/cost on 64640 and number of sides/levels since would be an accurate capture of similar resources.
June 2012 page 15
Frequently Asked Questions:Surgery: Nervous System
Question: May code 64640 be reported for each individual peripheral neurolytic nerve destruction procedure performed at the L5, S1, S2, and S3 nerves?
Answer: Yes. When performing individually separate nerve destruction, each peripheral nerve root neurolytic block is reported as destruction of a peripheral nerve, using code 64640, Destruction by neurolytic agent; other peripheral nerve or branch. In this instance, for peripheral nerve root neurolytic blocks (destruction) of L5, S1, S2, and S3, code 64640 should be reported four times. The coder should append modifier 59, Distinct Procedural Service, to the second and subsequent listings of code 64640 to separately identify these procedures.
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July 2014 page 8
Frequently Asked Questions:Surgery: Nervous System
Question: What is the appropriate code to report a radiofrequency sacroiliac joint ablation?
Answer:There is no specific CPT code that accurately describes this service. Therefore, the unlisted code 64999, Unlisted procedure, nervous system, should be reported. When reporting an unlisted code to describe a procedure or service, it may be necessary to submit supporting documentation (eg, procedure report) along with the claim to provide an adequate description of the nature, extent, and the need for the procedure, as well as the time, effort, and equipment necessary to provide the service.
Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management