Nerve Radiofrequency Ablations (RFA)

by  Find-A-Code™
Jan 1st, 2019 - Reviewed/Updated Apr 30th

Explanation

Radiofrequency ablation is a minimally invasive procedure that uses high-frequency alternating electrical current delivered through a needle electrode (or catheter) to generate heat that destroys (ablates) targeted tissue — most commonly nerves, tumors, or aberrant cardiac/venous tissue. The size of the ablation depends on RF current intensity, tip temperature, dwell time, electrode size, and tissue heat conduction; multiple probe positions may be needed for full coverage.

Reporting this service depends on the anatomic site, indication, and approach.

RFA may be performed following a nerve block which helps to identify the source of pain. Ablative procedures are used to remove or destroy lesions, tumors, fibroids, electrical pathways, nerves, muscles, and more. Patients suffering from back pain can have an ablation procedure performed to destroy or partially destroy spinal nerves, thereby removing the source of pain, sometimes for up to six months or more, until the nerve regrows and the procedure needs to be repeated. Radiofrequency ablation of a spinal nerve is performed in the following manner:

Following IV administration of a sedating medication, the patient is prepped and draped for the injection and the location of needle insertion is injected with an anesthetic to numb the area. Fluoroscopic imaging is used to identify the spinal region housing the nerves. Finally, using imaging, the RFA needle is guided into position next to the nerve to be ablated and tested for positive contraction (reaction). Numbing medicine is infiltrated through the needle to help with pain and the needle is heated with radiofrequency waves and touched to the nerve to create a lesion (via burning the nerve) for a set length of time. Upon withdrawal of the needle, sometimes a large amount of numbing medicine is deposited to provide additional pain relief. This procedure would then be repeated for each nerve to be ablated.

Medial branch RFA Codes

Cervical/Thoracic:     64633 First nerve
                                 64634 Each additional nerve
Lumbar/Sacral:         64635 First nerve
                                 64636 Each additional nerve

Note: Fluoroscopic guidance (77003) is bundled into these procedures and therefore not eligible for separate reimbursement.

Lateral branch RFA Codes:

RFA of the lateral branches of the spine are considered peripheral nerves and as such, would be reported as follows:

64640 Destruction by neurolytic agent; other peripheral nerve

For each nerve ablated, report a single unit of service. If four peripheral nerves are ablated, report 64640 x 4 units. Do not report this code with modifier 50, as it does not qualify as a unilateral procedure because a peripheral nerve can be anywhere in the body with no link to laterality. Imaging is also done under fluoroscopic guidance, and because no NCCI edit exists with 64640 and 77003, they can be billed together.

Tip: When imaging for this service is performed, it is billed with just one unit, not once for each peripheral nerve injected (77003 x 1 unit).

Sacroiliac (SI) Joint Nerves RFA Code

64625 RFA, nerves innervating the SI joint, with imaging guidance

Prior to 2020, RFA of a peripheral nerve (64640) was used to report RFA of the nerves innervating the SI joint. However, this change allows providers to more accurately report the exact anatomic location of the nerves that innervate the sacroiliac (SI) joint.

Note that code 64451 was also added in 2020 to report injection of an anesthetic agent and/or steroid into the nerves that innervate the SI joint.

Note: Code 64625 INCLUDES image guidance for needle placement (fluoroscopy and CT scan) so it would be inappropriate to bill guidance separately (e.g., 77002, 77003, 77012). However, if ultrasound was used, it may be billed with 76999.