# Lumbar rhizotomy



## MDPAYNE (Mar 15, 2011)

I have a physician doing a lumbar rhizotomy. His notes reads as follows : The patient was placed in prone position on the fluro table. Sterile prep and drape was applied.the proper level for needle placement was obtained using radiographic confirmation. Then 10mm tip 22-gauge insulated needles were sequentially placed over the junction of the superior articular process and the transverse process and the location of the mamillo-accessory notch. Then sensory stimulation and motor stimulation was performed. After adequate stimulating patterns were achieved, local anesthetic was injected through the needles. The lesioning was then done for 75 seconds at 80 degrees centrigrade at each level respectively and individually. The injection was done at the l4-l5, l5-s1 bilaterally. 

The doctor is indicating 6 sites. Not sure how to code. 
Would i use : 64622-50, 64623-50, 64623-50 and 77003-26?:


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## dwaldman (Mar 15, 2011)

Might want to indicate to the physician that if he is billing per nerve lesioned, the report could be  describe the nerves targeted not just the corresponding facet joint levels. This can be done by providing a heading or procedure description before the narrative such as an I example I found:

1) Neurolysis medial branches of the primary posterior rami L3, L4 (BILATERAL)
2) Neurolysis dorsal ramus L5 (BILATERAL)

 The claim reviewer might see L4-L5 and L5-S1 and not be able to read between the lines of the corresponding nerves and not be able to abstract 3 levels performed bilateral when they are just seeing it listed by facet joint levels.


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## MFREUTEL (Mar 17, 2011)

You only code it twice, 64622-50 and 64623-50 plus the flouro. My doctors do this procedure a lot.


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