Q & A with Dr. Z: Radiofrequency Ablation Sacral Ala & Lateral Branches

by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC

For the following dictation, what can be coded?

“Procedure: Fluoroscopy guided radiofrequency ablation at right sacral ala and lateral branches at S1, S2, and S3 (12 sites). Detail: Following informed consent, and with the patient under general anesthesia, she was prepped and draped in usual sterile fashion. The skin and subcutaneous tissue were anesthetized. Following this I used a 22 gauge angulated 150 mm exposed tip needle at each level, correctly placing them under fluoroscopic guidance at right sacral ala and lateral branches at S1, S2, S3. After stimulating at each level without evidence of motor signs, I performed radiofrequency ablation at each site, heating the affected nerves to 80 degrees centigrade for 90 seconds. A total of 12 sites were heated and treated. I removed the needles and applied sterile dressings.”

Would it be coded as 64640 x 4 (for the levels) or 64640 x 12 (for the 12 sites)?

In 2020, I would code this as 64625-50 (RF ablation of nerves innervating the SI joint, which is a new code for 2020) one time. In 2019, it would be reported with 64640-50 x 4.


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About the Author

David Zielske is founder and President of ZHealth Publishing and primary author and editor of ZHealth publications. Dr. Z practiced as an interventional radiologist and has over twenty years experience as a coding reviewer and coding expert. He is Board Certified in Radiology and has functioned as an independent interventional radiology, vascular surgery, and cardiovascular coding consultant to a variety of physician groups and hospital providers across the country. He also served as an instructor for over 200 coding seminars.

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