What is the CPT Code for Genicular Nerve Left Knee RFA or Destruction of Three Branches – superior medial and lateral branches and the inferior medial branch

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According to CPT Assistant published in January 2018 CPT Assistant issue included this Q&A:

Question: What code(s) is used to report an injection on the superior medial and lateral branches and the inferior medial branch of the left genicu-lar nerve performed for destruction with a neurolytic agent?

January 2018 CPT Assistant Q&A

Answer:

Code 64640 -, Destruction by neurolytic agent; other peripheral nerve or branch, may be reported for each nerve destruction. Therefore, if destruction is performed on the superior medial and lateral branches and the inferior medial branch of the left genicular nerve, it would be appropriate to report code 64640 three times or report code 64640 once with three units of service based on payer preference.

The coder should append modifier 59, Distinct Procedural Service, to the second and subsequent listings of code 64640 to separately identify these procedures.

What CPT Code is used for Genicular Nerve Knee RFA or Destruction of Three Branches – superior medial and lateral branches and the inferior medial branch

Coding and Billing for Genicular Nerve Left Knee RFA

Illustration:

  • Scenario No. 1 – Report CPT Code 64640 – LT x 3 units
  • Scenario No. 2 – Report CPT Code 64640 (3 times) see example below
    1. 64640 LT x 1 unit
    2. 64640 59 LT x 1 unit
    3. 64640 59 LT x 1 unit

How about the CPT Code for the Genicular Nerve Block of three superior medial and lateral branches and the inferior medial branch, what CPT Code is used and how many units will you report using the code?

Documentation must clearly indicate the nerve injected and the substance administered.

Genicular nerve block of three branches around the knee joint
CPT Assistant, November 2015 Page: 11 Category: Frequently Asked Questions

Question:
When a physician injects the superior medial and lateral branches and inferior medial branches of the left genicular nerve, is code 64450 reported three times or just once for the left genicular nerve?

Answer:
I
t is appropriate to report code 64450, Injection, anesthetic agent; other peripheral nerve or branch, for the genicular nerve block of three branches of this nerve around the knee joint;

however, code 64450 is reported just once during a session when performing the injection(s).

Although one, two, or more injections may be required during the session, the code is reported only once, irrespective of the number of injections needed to block this nerve and its branches.

REMEMBER: What about the Fluoroscopic Guidance, is it separate?

Can you bill for the CPT Code 77002 for the Fluoro? – the answer is NO.

The CPT Code 77002 is now an ADD-On code per AMA’s CPT Guideline. There are codes that you can only bill with CPT 77002.

According to the AMA CPT:

CPT Code 77002 – Fluoroscopic guidance for needle place (eg. biopsy, aspiration, injection, localization device) (List separately in addition to code for Primary Procedure).

(See appropriate Surgical Code for Procedure and Anatomic Location)

Use 77002 as an “add-on” code with 10022, 10160, 20206, 20220, 20225, 20520, 20525, 20526, 20550, 20551, 20552, 20553, 20555, 20600, 20605, 20610, 20612, 20615, 21116, 21550, 23350. 24220, 25246, 27093, 27095, 27370, 27648, 32400, 32405, 32553, 36002, 38220, 38221, 38505, 38794, 41019, 42400, 42405, 47000, 47001, 48102, 49180, 49411, 50200, 50390, 51100, 51101, 51102, 55700, 55876, 60100, 62268, 62269, 64505, 64508, 64600, 64505)

KEY TO REMEMBER!

  • For Genicular Nerve Block – report only 1 unit of 64450 even if the 3 branches were blocked
  • For Genicular Nerve RFA or Genicular Nerve Destruction – report 64640 3 times or 3 units

References:

  • CPT Assistant, November 2015 Page: 11 Category: Frequently Asked Questions
  • CPT Assistant, January 2018 CPT issue included this
  • CPT Code Books 2018 and ICD-10 Code Books
  • CPT is a Trademark and owned by the American Medical Association
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