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Treating the Genitofemoral Nerve?

Christine Woolstenhulme, CPC, CMRS, QCC, QMCS

Finding which CPT code is appropriate for certain nerves can get complicated. Recently I was asked which CPT code would be used for radiofrequency ablation of the genitofemoral nerve and for a second procedure: release of psoas tendon under ultrasound guidance.

Radiofrequency Ablation of the Genitofemoral Nerve

I found is there is no code specifically for the genitofemoral nerve. Therefore, let's explore this procedure a little deeper. First, we need to understand the anatomy of the genitofemoral nerve to understand the best fit when reporting a CPT code. NCBI explains to us the anatomy of the abdomen and pelvis, as well as the genitofemoral nerve, stating, “The genitofemoral nerve arises from the lumbar plexus. It supplies sensation to the skin of the anterior scrotal area in males, mons pubis in females, and the upper segment of the anterior thigh in both males and females. While distinct from the femoral nerve, the genitofemoral nerve originates from the upper lumbar segments L1-L2. It then descends inferiorly, piercing the psoas major muscle before emerging on its anterior surface.  The nerve then traverses the retroperitoneum, descending over the anterior surface of the psoas muscle. The nerve continues inferiorly, ultimately separating into two divisions- the femoral and the genital branches. When the genitofemoral nerve reaches the groin area, it enters the deep inguinal ring coursing through the inguinal canal.”

An article from Decision Health, July 2010 issue states,"Code 64450 may include metatarsal, digital, sural, peroneal, saphenous, tibial, obturator, femoral cutaneous, femoral, genitofemoral, auriculotemporal, greater auricular, radial, median cutaneous, intercostobrachial, medial and ulnar blocks, lumbar plexus."

This brings us to two codes that may apply;

64450  is a procedure injecting anesthetic agent(s) and/or steroid; into other peripheral nerve or branch.  Since the genitofemoral nerve is in a peripheral nerve, we could use 64450.  The purpose of a nerve block is to block pain signals to the brain to provide temporary relief. However, the treatment was done by radiofrequency technique, not an injection. 

Let's take a look further into a code for destruction such as 64640, indicating destruction of other peripheral nerve or branch by a neurolytic agent; this code may be performed by injection of a chemical neurolytic agent or using thermal, electrical, or radiofrequency techniques. We would use 64640 for the destruction of a peripheral nerve if there is not a more specific code. 

CPT instructs: "Do not select a CPT code that merely approximates the service provided.  If no such procedure or service exists, then report the service using the appropriate unlisted procedure or service code."

If there is no code and you are using an unlisted CPT code, I suggest referencing the closest code to establish a fee for the procedure. Also, be sure to include documentation including, but not limited to:

  • Op report
  • A clear definition and description of the procedure
  • The nature of the procedure and extent indicate why it cannot be included with another CPT   

Release of Psoas Tendon Under Ultrasound Guidance

The psoas or iliopsoas is a muscle located in the front of the hip joint it is the primary hip flexor of the body providing flexion. According to the AMA CPT® Assistant - 2017 Issue 4 (April) "Currently, there is no specific CPT code to report an arthroscopic iliopsoas tendon release, therefore, it may be appropriate to report code 29999, Unlisted procedure, arthroscopy." Use only if the procedure was done arthroscopically.

Aetna Policy Number: 0736 states the following, "Iliopsoas tendon release surgery and capsular release surgery are considered integral to the primary procedure and not separately reimbursable."  

Being unable to find a code for percutaneous release under ultrasound guidance for iliopsoas tendon release, there are only two approaches, endoscopic and open surgery.  It sounds like the provider may have done a percutaneous approach, so you may want to consider 27299- Unlisted procedure Pelvis/Hip Joint.  CPT code 76942 may also be considered for ultrasonic guidance.

We have listed a few suggestions for consideration that may or may not apply to your exact situation. I would suggest contacting your provider representative for more accurate coding according to their policy. The above are a few suggestions that may be applicable, knowing the anatomy is the first place to start.