Wiki Low-grade energy (<80 degrees) Rhizotomy (64999)

[jowill]

The procedure performed was a bilateral cervical medial branch facet rhizotomy at C3-4, C4-5, C5-6, and C6-7 levels. This was done at a low-grade energy (<80 degrees) so according to CPT; we must bill unlisted code 64999. The 50 modifier is invalid for 64999 but my question is how do we convey to the insurance carrier that this was a multi-level bilateral procedure? For example, would it be appropriate to bill 64999x4 units; 64999 on 4 charge lines, etc.?

 

[dwaldman]

I would bill 64999 with one unit they will manually price the claim and take the total procedure into consideration. I would write a cover letter and state we believe the comparison in reimbursement would be accurately reflected by looking at the pricing for: 64633-50 64634-50 64634-50, etc..