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billing for peripheral nerve ablation rfa

2/27/2021

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Pain Management coding and billing can be confusing. You must have at least a little knowledge with Anatomy and Physiology to be successful in this area of billing and coding.
Billing for Peripheral Nerve Ablation Revenue Cycle Management Gohealthcarecllc.com
Your Billing Codes for the Peripheral Nerve Ablation are listed below.
​64600 
Destruction by neurolytic agent, trigeminal nerve; supraorbital, intraorbital, mental, or interior alveolar branch

64605
Desctruction by neurolytic agent, trigeminal nerve; second and third division branches at
foramen ovale

64610
Desctruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale under radiologic monitoring

64620 
Destruction by neurolytic agent, intercostal nerve 

64624 
Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed

64630 
Destruction by neurolytic agent, pudendal nerve 

64640 
Destruction by neurolytic agent, other peripheral nerve or branch 

64680 
Destruction by neurolytic agent, with or without radiologic monitoring; celliac plexus

64681
Destruction by neurolytic agent, with or without radiologic monitoring; superior hypogastric plexus
Below are the list of billing codes for Peripheral Nerve Block Injection.
Looking for Revenue Cycle Management for Pain Management Company
​64400 
Injection, anesthetic agent; trigeminal nerve, any division or branch

64418 
Injection, anesthetic agent; suprascapular nerve

64420 
Injection, anesthetic agent; intercostal nerve, single

64421 
Injection, anesthetic agent; intercostal nerves, multiple, regional block

64425 
Injection, anesthetic agent, ilioinguinal, iliohypogastric nerves

64430 Injection, anesthetic agent, pudendal nerve

64447 Injection, anesthetic agent; femoral nerve, single

64450 
Injection, anesthetic agent; other peripheral nerve or branch

64454  
Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed

64505 
Injection, anesthetic agent; sphenopalatine ganglion

64510 
Injection, anesthetic agent; stellate ganglion (cervical sympathetic)

64517 
Injection, anesthetic agent; superior hypogastric plexus

64520 
Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic)

64530 
Injection, anesthetic agent; celiac plexus, with or without radiologic monitoring
Key points to remember:
  • These code(s) can be unilateral (so make sure you append the right anatomical side MODIFIER);
  • Some code(s) may be inclusive with the imaging guidance (you cannot bill it separate);
  • Always check with the payers if your procedure(s) will need Prior Authorization or Precertification
  • Always verify if it is a covered benefits for your patients.
  • You can report for Moderate Conscious Sedation code 99152-99153 if performed by the same physician and patient is older than 5 years old.

    Contact us today if you need help getting paid!

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Genicular nerve block denial and appeal

2/27/2021

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Effective January 1, 2020, we have now a specific code for the Genicular Nerve Knee Block and the Genicular Nerve Knee Ablation. You can read more about that change in our blog. CLICK HERE.

Understanding the Genicular Nerve (image below)

GENICULAR NERVE BLOCK DENIAL AND APPEAL
64454
Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed
64624
Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed
I have been getting inquiries about their claims getting denied by the insurance payers including some contractors of Medicare. What I found is that, this is considered as Investigational and Experimental.
I commonly see the following guideline:
Genicular nerve blocks and genicular nerve ablation are considered investigational and not medically necessary for the treatment of chronic knee pain, including but not limited to any of the following:
  • Degenerative joint disease;
  • Osteoarthritis of the knee;
  • As a treatment prior to knee replacement;
  • As a treatment following knee replacement;
  • As a treatment for individuals who are not candidates for knee replacement surgery.
I have seen two CMS Contractor who covers for this procedure based on Medical Necessity. See Group 1 Diagnosis Codes Cross Over:

Group 1 DX Codes:
M25.561 Pain in right knee
M25.562 Pain in left knee
Read more about guidelines:
National Government Services Inc Billing and Coding: Peripheral Nerve Blocks (A57452)
First Coast Service Options, Inc Billing and Coding: Peripheral Nerve Blocks (A57788)
More Guidelines from Payers which consider the procedure to be Investigational:

Aetna Healthcare
Anthem Blue Cross Blue Shield

How do you handle Denial and Appeal for Genicular Nerve Ablation or Genicular Nerve Block?
Here are my tips:
  • Avoid the denials in the first place! by knowing your payers' guidelines;
  • If the Provider says its Medically Necessary for the patient to receive the genicular nerve block or genicular nerve ablation, try getting a Predetermination based on Medical Necessity from your Payer! They will not allow you to submit Prior Authorization because for sure, it does not need Prior Authorization because its not a covered benefit based on their policy because the payer consider it "investigational" or "experimental"; Insist on reviewing Predetermination based on Medical Necessity instead!
  • Already having denied claims? - pursue the claims by sending appeals, get your patient get involved with the appeals process. Be prepared with your medical documentation! How's the Patient's Pain Relief? Duration of Pain Relief? Improved ADL? - include that all in your documentation!
Searched Keywords: GENICULAR NERVE BLOCK DENIAL AND APPEAL CPT BILLING CODE 64454
How to Get Paid for Genicular RFA Ablation Denial
How to Get Paid for Genicular RFA Ablation Denial
Need help how to Appeal your claims? Contact Us today!
Need help how to obtain Pre-determination before you render the Genicular Nerve Block to your patients? You should contact us today!

    Contact us today.

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Searched Keyword: Revenue Cycle Management Company for Interventional Pain Management
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    ABOUT THE AUTHOR:
    Ms. Pinky Maniri-Pescasio is the Founder of GoHealthcare Consulting. She is a National Speaker on Practice Reimbursement and a Physician Advocate. She has served the Medical Practice Industry for more than 25 years as a Professional Medical Practice Consultant.

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    Pain Management Billing Codes
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  • About
  • Services
    • Prior Authorization Services
    • Patient Access Services
    • Medical Scribe Services
    • Coding and Documentation Audit Review
    • ​E/M & Surgical Coding Education and Training
    • RCM FULL SERVICES
  • READ OUR BLOG
  • Let's Meet in Person
    • 2023 ORTHOPEDIC VALUE BASED CARE CONFERENCE
    • 2023 AAOS Annual Meeting of the American Academy of Orthopaedic Surgeons
    • 2023 ASIPP 25th Annual Meeting of the American Society of Interventional Pain Management
    • 2023 Becker's 20th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference
    • 2023 FSIPP Annual Conference by FSIPP FSPMR Florida Society Of Interventional Pain Physicians
    • 2023 New York and New Jersey Pain Medicine Symposium
  • Testimonials
  • Frequently Asked Questions and Answers - GoHealthcare Practice Solutions
  • FREE ASSESSMENT
  • Readers Questions