Neurosurgery Coding Alert

Question: Our physician used radiofrequency for neurolysis of the greater occipital nerve. This was done for therapeutic purpose. He did the rhizotomy on both the right and the left side. How should we code for this procedure?

Virginia Subscriber

Answer: For greater occipital nerve rhizotomy, you report code 64640 (Destruction by neurolytic agent; other peripheral nerve or branch). According to the information you have shared, your physician used radiofrequency for the purpose of rhizotomy. Because your physician performed the procedure on both the right and left sides, you can bill the code bilaterally. Depending upon the payer, report the destruction as one of the following: 

• 64650-50 x 1 unit of service; or
• 64640-RT x 1 unit of service and 64640-LT x 1 unit of service.

What is rhizotomy? Rhizotomy is a neurosurgical procedure in which your surgeon targets to destroy a damaged nerve or tract that is causing problem in the patient. In most cases, your surgeon will do this procedure to relieve refractory pain in the patient.