Wiki Endoscopic Rhizotomy compare to code

[bnmellon]

I have been trying to figure out how to code the following. My provider wants to use cpt 64999 but am not sure what to compare it to. Before I took over the coding for this provider, they were using 64772. Any help would be greatly appreciated.

"Attention was first paid to the left L4 dorsal ramus medial/lateral branches. Using AP and lateral intra-operative fluoroscopy the starting point of the superior articular process and the transverse process of the left L5 vertebrae was identified. A skin incision was then made and sequential dilators were used to dissect down to the planned starting point. A tubular retractor was then placed and an endoscope was inserted with constant saline irrigation. Biplanar fluoroscopy confirmed correct position and then bipolar electrocautery with an RF probe was used to clear soft tissue off of the transverse process and superior articular process junction. The medial/lateral branches of the dorsal ramus of the left L4 nerve root were identified and transected with an endoscopic scissor. Final visual confirmation confirmed complete removal of all soft tissue overlying the transverse process, superior articular process junction."

Thanks

 

[lexvcarter]

Per the AAOS and AMA, there are no codes that describe when the mechanical destruction is performed during an open spinal procedure. The unlisted code, CPT 64999 must be used.
When performed during an open spinal procedure, if the surgeon doesn’t describe the “mechanical destruction” of nerve(s) in the operative notes except to say that it was via endoscope, this leads the adjusters to presume that the standard of care and work involved in this procedure is similar to the nerve destruction as described above using CPT codes 64633, 64634, 64635, and 64636 like an injection/needle via a catheter.