Neurology & Pain Management Coding Alert

Question: An established patient with a current diagnosis of tic douloureux reports to the practice for an office visit. During the encounter, the patient describes severe facial pain lasting the past six days. He rates the pain as 9 on a scale of 10. The physician identifies the source of the pain and performs destruction of the supraorbital trigeminal nerve using an electrical current. The physician also injected corticosteroids for therapeutic purposes. What is the correct coding for this encounter?

New York Subscriber

Answer: On the claim, you should report:

• 64600 (Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch) for the nerve destruction
• G50.0 (Trigeminal neuralgia) appended to 64600 to represent the patient’s symptoms.

For your scenario, you do not need to include R52 (Acute pain NOS) as a diagnosis code because this pain is an integral component of the trigeminal neuralgia diagnosis.

What about corticosteroids? When your physician performs destruction by neurolytic agent, he will often inject other therapeutic agents, such as local anesthetic and/or corticosteroids, during the procedure. In these instances, the corticosteroid administration is not separately codeable; the work units for 64600 cover the therapeutic agent injection.

Also, make sure that you don’t report a code that includes “destruction” when the therapy doesn’t eradicate the target nerve — such as pulsed radiofrequency. When the physician doesn’t destroy the target nerve, use code 64999 (Unlisted procedure, nervous system) for the procedure.