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Topic: Review nerve destruction codes

Ambulatory Surgery Reimbursement Update, July 22, 2008

Watch out when coding CPT codes 64600–64681, which are nerve destruction codes, because the potential for overcoding exists. A note in the 2008 CPT Manual above code 64600 states that these codes already include the injection of other therapeutic agents (e.g., corticosteroids). This note is the reason for common coding errors. For these procedures, nerves are destroyed with a heating probe or cryoprobe (a freezing technique).

If a patient comes in to have destruction of a particular nerve performed, and afterward the physician injects a corticosteriod for therapeutic services into the same nerve, the guideline clearly states that this code range already includes therapeutic services. Therefore, you should not separately report a nerve destruction code.

“It’s possible that insurance companies could come back and say they want their money back,” says Lolita M. Jones, RHIA, CCS, principal, Lolita M. Jones Consulting Services, Fort Washington, MD. “This is also a compliance issue.”

It is also not correct to apply destruction by neurolytic agent codes 64600–64681 to report pulse radiofrequency (PRF), which many physicians use as a nerve destruction technique. The AMA guideline in CPT Assistant, August 2005, states that no specific CPT code exists that accurately describes PRF; therefore, coders should report unlisted code 64999 (unlisted procedure, nervous system).

Editor's note: This topic is from the July 2008 issue of Ambulatory Surgery Coding & Reimbursement Insider.

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