Treating the Genitofemoral Nerve?

January 25th, 2022 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Categories:   Coding   Neurology|Neurosurgery  

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.  


Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.

Latest articles:  (any category)

Artificial Intelligence in Healthcare - A Medical Coder's Perspective
December 26th, 2023 - Aimee Wilcox
We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities? 
Specialization: Your Advantage as a Medical Coding Contractor
December 22nd, 2023 - Find-A-Code
Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.
ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD)
December 19th, 2023 - Aimee Wilcox
Chronic respiratory disease is on the top 10 chronic disease list published by the National Institutes of Health (NIH). Although it is a chronic condition, it may be stable for some time and then suddenly become exacerbated and even impacted by another acute respiratory illness, such as bronchitis, RSV, or COVID-19. Understanding the nuances associated with the condition and how to properly assign ICD-10-CM codes is beneficial.
Changes to COVID-19 Vaccines Strike Again
December 12th, 2023 - Aimee Wilcox
According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.
Updated ICD-10-CM Codes for Appendicitis
November 14th, 2023 - Aimee Wilcox
With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.
COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....

Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association