Getting paid for Pulsed RF

[dahlilama]

I have had difficulty getting pain for pulsed RF to the DRG for refractory radicular pain. My coder uses 64999 which is denied. Another option reported is as per below. Have any of you had success and lack of headaches with using this code? Thanks.

http://www.supercoder.com/coding-ne...-guidelines-for-pulsed-radiofrequency-article

"You Be the Coder: Verify Guidelines for Pulsed Radiofrequency


Question: What code should I report for pulsed radiofrequency? I have information stating we should use 64999 (Unlisted procedure, nervous system), but I also have a copy of a letter from the AMA dated July 20, 2004, stating that the CPT advisers changed their minds on their original decision and that the codes from the "destruction by neurolytic agent" series can be used.


Delaware Subscriber


Answer: Check the carrier guidelines to determine the correct approach. Some coders still report 64999, but others select the correct code from the 64600-64640 series (codes related to Somatic nerve destruction by neurolytic agent [e.g., chemical, thermal, electrical or radiofrequency]). Coders reporting from this group say they don't usually have problems being paid for the procedures."

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[bedrock]

You're not going to be paid by insurance 98% of the time you do pulsed RF.

Cash-pay only procedure for my office.

 

[drf]

pRF is interesting. I do a lot of it at an academic center. I always inject some local and steroid and bill 64999, whatever injection code, and US or fluoro guidance.

My billers tell me it gets paid. I've only done a peer-to-peer once in the last year, and that was 6 months after the procedure. Occipital and they were refusing the prior diagnostic block as well as follow up block and RF so my sense was that they were worried about occipital block rather than pRF.

What it pays is anyone's guess. It is impossible to get the hospital to fess up to any numbers on anything I do. But I'm still doing them.

 

[bedrock]

pRF is interesting. I do a lot of it at an academic center. I always inject some local and steroid and bill 64999, whatever injection code, and US or fluoro guidance.

My billers tell me it gets paid. I've only done a peer-to-peer once in the last year, and that was 6 months after the procedure. Occipital and they were refusing the prior diagnostic block as well as follow up block and RF so my sense was that they were worried about occipital block rather than pRF.

What it pays is anyone's guess. It is impossible to get the hospital to fess up to any numbers on anything I do. But I'm still doing them.

Unless they give you cold hard numbers, I wouldn't believe them. Maybe you're making $8 per 30m pRF case.

Nice thing about private practice is knowing exactly what you get paid. If Something stops being paid, I know right away and patient get the option of cash-only or no procedure.

I think pRF has a lot of potential, but I didn't train for 13 yrs to work for free.

 

[drf]

I had one inpatient who responded great to bilateral GON blocks. She was scheduled for oupatient block and pRF. On the day of her outpatient procedure she had lost insurance, but wanted to self pay as the blocks worked so well.

In preop registration I had her talk to patient services for financial assistance. They told her the discounted self pay portion of B GON block and pRF was $25,000. She opted against self paying...

 

[ampaphb]

"You Be the Coder: Verify Guidelines for Pulsed Radiofrequency


Question: What code should I report for pulsed radiofrequency? I have information stating we should use 64999 (Unlisted procedure, nervous system), but I also have a copy of a letter from the AMA dated July 20, 2004, stating that the CPT advisers changed their minds on their original decision and that the codes from the "destruction by neurolytic agent" series can be used.


Delaware Subscriber


Answer: Check the carrier guidelines to determine the correct approach. Some coders still report 64999, but others select the correct code from the 64600-64640 series (codes related to Somatic nerve destruction by neurolytic agent [e.g., chemical, thermal, electrical or radiofrequency]). Coders reporting from this group say they don't usually have problems being paid for the procedures."

pRF is non-destructive. Using any CPT code that characterizes the procedure that way would be fraudlent