Ask Dr. Z

Radiofrequency lesions were created with a temperature of 80 degrees Celsius for 80 seconds at the following stated levels. First, the right L5 dorsal ramus was targeted. The right sacral ala was identified using fluoroscopy. The skin over this area was anesthetized with 2 cc 1% lidocaine using a 26-guage 1-1/2 inch needle. Then, a 20-gauge 150 mm Stryker Venom needle with a 10-mm active curved tip was advanced to the sacral ala. Next, the right L4 medial branch was targeted at the junction of the transverse process and superior articulating process of the L5 vertebral body. Next, the right L3 medial branch was targeted at the junction of the transverse process and superior articulating process of the L4 vertebral body. Would the recommended coding be 64635-RT, 64636-RT or 64635-RT, 64636-RT (modifier 59), 64625-RT, or 64635-RT, 64636-RT x 2? There is no mention of the sacral nerves being specifically targeted. Seems like 3 levels (L5-S1, L4-L5, and L3-L4) were RFA’d- any guidance would be much appreciated for coding this.