Ask Dr. Z

For the following dictation, what can be coded? Would it be coded as 64640 x 4 (for the levels) or 64640 x 12 (for the 12 sites)? “Procedure: Fluoroscopically-guided radiofrequency ablation at right sacral ala and lateral branches at S1, S2, and S3 (12 sites). Detail: Following informed consent, and with the patient under general anesthesia, she was prepped and draped in usual sterile fashion. The skin and subcutaneous tissue were anesthetized. Following this I used a 22 gauge angulated 150 mm exposed tip needle at each level, correctly placing them under fluoroscopic guidance at right sacral ala and lateral branches at S1, S2, S3. After stimulating at each level without evidence of motor signs, I performed radiofrequency ablation at each site, heating the affected nerves to 80 degrees centigrade for 90 seconds. A total of 12 sites were heated and treated. I removed the needles and applied sterile dressings.”