Endoscopic Dorsal Ramus Rhizotomy

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Question:

We just hired a new neurosurgeon and he is doing rhizotomies endoscopically. He says he uses a working channel in the endoscope that allows passage of a radiofrequency probe so he can see the nerves as the probe locates and ablates the medial branches of the dorsal ramus. We’ve been billing 63190-52 (Laminectomy with rhizotomy; more than 2 segments) and the reduced service modifier indicates we didn’t do the laminectomy. One of our insurance companies recently denied this after they reviewed the operative report. What should we do?

Answer:

Unfortunately there is not a CPT code that describes an endoscopic rhizotomy procedure. Remember, CPT says if there is not a code then we should use an unlisted code and not an existing code with modifier 52. Therefore, the most appropriate way to report this procedure is with 64999 (Unlisted procedure, nervous system).