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AHA Coding Clinic® for HCPCS - 2024 Issue 3; Ask the Editor

Radiofrequency ablation (RFA) reporting for the lumbar and sacral regions

A patient with lumbosacral spondylosis and left facet arthrosis presents for a lumbar facet joint medial branch rhizotomy of the nerves of the L3-L4, L4-L5, and L5-S1 facet joints. Using a slightly oblique angle, the facet joint articular spaces from L1 to L5 were visualized. The view of the joint space was optimized by using the caudal cranial tilt. The junction of the superior articular and the transverse processes was the target location. A curved 100 mm probe with an active tip was advanced using various approaches under fluoroscopic guidance, until the needle contacted the periosteum at the L3, L4, L5, and L5 dorsal ramus nerves on the left. The L5 dorsal rami nerve was identified by a probe placed between the sacral ala and the superior articular process of the sacrum. All needles were placed upon the periosteum and neuromonitoring was utilized to rule out nerve root or motor nerve involvement. The probes were heated, and the lesions were ablated at a temperature of 80 degrees Celsius for 90 seconds, creating one lesion at each level using needles to improve RFA lesion size. Would codes 64635 and 64636 be the correct codes for the levels treated? When the nerves being treated are considered medial or lateral branches, does that make a difference in code assignment? ...

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