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Genicular RFA coding 64640 or 64450 - conflicting advice

Julie Posted Thu 27th of August, 2015 13:16:45 PM

Hi

I found conflicting advice re: coding for a Genicular RFA and need to know which is correct. One answer (64499) is from Supercoder Ask an. The other answer (64640) is from the Supercoder BOLT newsletter. We have done the diagnostic injections and now plan to do the destruction of lesions via the RFA. This is our first time billing this due to a new MD on staff. Help!

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Genicular nerve block and RF
1. User id : 14912 Posted 7 months ago

If a physician is injecting multiple areas of the genicular nerve - (superior lateral, superior medial and inferior medial) would you bill 1 - 64450 or would you bill it quantity 3 with modifier 51? Also would the RFA of this nerve be code 64999?
2. SuperCoder Posted 7 months ago

The knee joint is innervated by the articular branches of various nerves, including the femoral, common peroneal, saphenous, tibial, and obturator nerves. These branches around the knee joint are known as genicular nerves. If the provider specifically documents in the record that he has performed injection in different branches, you can use multiple units of code 64450 with modifier 51.
Yes, code 64999 would be most appropriate for RFA of this nerve.
Thanks !!
- See more at: https://www.supercoder.com/my-ask-an-expert/topic/genicular-nerve-block-and-rf#sthash.OIOkHT9b.dpuf

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Reader Question: Choose 64450 for Genicular Nerve Injection
Posted on 24. Jun, 2015 by rpandit in Coding Challenge
Question: Our physician injected multiple branches of the genicular nerve (superior lateral, superior medial, and inferior medial). Do we report 64450 once, or bill it three times with modifier 51? Also, what would be the correct code for thermal radiofrequency ablation of this nerve?
Delaware Subscriber

Answer: If the provider specifically documents in the record that he has performed injections in different branches, you can use multiple units of code 64450 (Injection, anesthetic agent; other peripheral nerve or branch) with modifier 51 (Multiple procedures).

Anatomy lesson: The knee joint is innervated by the articular branches of various nerves, including the femoral, common peroneal, saphenous, tibial, and obturator nerves. These branches around the knee joint are known as genicular nerves.

Since the genicular nerve branches are considered to be somatic nerves, if the physician performed thermal radiofrequency ablation (RFA), you would bill 64640 (Destruction by neurolytic agent; other peripheral nerve or branch). This code, similar to the 64450 injection code, is based on each individual nerve or nerve branch and as such it would be billed with 3 units of service if the physician ablated all three individual nerve branches

http://codingnews.inhealthcare.com/coding-challenge/reader-question-choose-64450-for-genicular-nerve-injection/

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Thanks in advance

Julie Posted Thu 27th of August, 2015 13:20:34 PM

sorry - typo in codes
64999 or 64640

SuperCoder Answered Fri 28th of August, 2015 02:30:47 AM

Well, destruction by neurolytic agent has to be considered for ablation using radiofrequency. Appropriate code for the procedure is 64640. As far as CPT 64999 is concern, it should be used when the ablating pattern or agent of destruction is not mentioned i.e. unspecified agent/ undetermined ablating material is been used. Hope it gives you a clear picture.

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