How to Bill for Knee Genicular Nerve Branches RFA or Ablation, Destruction Billing for the Genicular Nerve Branches RFA have been a struggle since it was not too clear to us on how we should be billing for this service. The good news is, we have a new code for this effective January 1, 2020. New CPT 2020 Changes. New Pain Management 2020 Codes. When your physician is performing an RFA on Genicular nerves, use code 64624 (Destruction by neurolytic agent of genicular nerve branches). Take note of the word "branches". These changes are explained as follows: Destruction by Neurolytic Agent (eg, Chemical, Thermal, Electrical or Radiofrequency), Chemodenervation on the Somatic Nerves CPT CODE 64624 Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed (Do not report 64624 in conjunction with 64454 - Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed Pay attention to this, the CPT 64624 requires the destruction of each of the following genicular nerve branches: (make sure your Provider had documented this!)
If a neurolytic agent for the purposes of destruction is not applied to all of these nerve branches, you can report CPT 64624 but you MUST append the MODIFIER 52: 64624-52 What is Modifier 52? Modifier 52 is usually used for reduced services. It may occur under certain circumstances that a service or procedure is partially reduced or eliminated at the physician’s discretion. There can be several reasons behind the physician’s decision. In this situation, service provided can be identified by its usual procedure number and the addition of the modifier 52, which indicates that the service was reduced. Understanding the 3 Genicular Nerve Branches of 64624 Image Source: https://ainsworthinstitute.com/genicular-neurotomy/  What is the CPT code for Knee Genicular Nerve Branches Block or Injection? Understanding the 3 Genicular Nerve Branches of 64454 Source: https://ainsworthinstitute.com/genicular-neurotomy/ When your Physician is Blocking the Knee Genicular Nerves - here's your code: (pay attention with the imaging! it is included!). CPT 64454 - Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches; (make sure your Provider had documented this!)
If all 3 of these genicular nerve branches are not injected, report 64454 with Modifier; 64454-52 What is Modifier 52? Modifier 52 is usually used for reduced services. It may occur under certain circumstances that a service or procedure is partially reduced or eliminated at the physician’s discretion. There can be several reasons behind the physician’s decision. In this situation, service provided can be identified by its usual procedure number and the addition of the modifier 52, which indicates that the service was reduced. Article Source: CPT Assistant December 2019 page 8 Destruction by Neurolytic Agent (Genicular Injection; Radiofrequency Neurotomy Sacroiliac Joint) For Current Procedural Terminology Got additional questions or concerns? call us today! Billing Tip: Always make sure you understand and you know the Medical, Clinical, Utilization and Reimbursement Policy of your Payers. Read other blog posts:
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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 Consultant. search hereArchives
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