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Medial branch endoscopic rhizotomy CPTs

Tasneem Posted Tue 14th of April, 2020 19:27:02 PM
Hi, Can you please advise what CPTs I can bill for this procedure done by a pain management doctor at the surgery center: Right L3, L4, and L5 medial branch endoscopic rhizotomy with a guidance of fluoroscopy. ICDs: M62.838, M54.5 Thanks
SuperCoder Answered Wed 15th of April, 2020 05:43:25 AM

Hi Tasneem,

Thank you for your question.

Rhizotomy is also called radiofrequency neurotomy.

Report codes 64635 x1 (for L3-L4) and 64636 (L4-L5) for the above procedure. Fluoroscopy is included in these procedures and should not be reported separately.

NOTE:

For bilateral procedure, modifier 50 may be appended.

Tasneem Posted Thu 16th of April, 2020 00:03:33 AM
Hi, do you know if we can also use CPT 64772 for this procedure with 76000 for fluoroscopy?
SuperCoder Answered Thu 16th of April, 2020 08:32:13 AM

Hi Tasneem,

Medial nerves are connected to a specific facet joint. If we have undergone medial branch endoscopic rhizotomy, it means we are performing median nerve block by destruction with radiofrequency or small incision on the nerve roots (sever).

So, it will be appropriate to use codes 64635 x1 (for L3-L4) and 64636 (L4-L5) for the above procedure.

To understand the procedure we may have to know the definitions below. It will give us clear picture to understand what exactly is been performed.

NOTE:

Rhizotomy: there are two common types of rhizotomy, radiofrequency ablation and endoscopic rhizotomy. Both control pain and are same but are performed in different ways.

Endoscopic rhizotomy: Involves using a small camera to find the affected location. The camera makes easy to identify problem area. Once they find the location to operate, they make a small incision (cut) on the nerve roots.

radiofrequency ablation procedure: The doctor uses heat to disable or destroy the nerve that causes the patient’s back pain and identifies defective nerve with the help of fluoroscopic X-ray.

neurolytic block is a process in which neurolytic agents are used for freezing or heating ("neurotomy") or the application of chemicals ("neurolysis") to block pain.

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