Obtain Proper Reimbursement for Treating Trigeminal Neuralgia
Published on Tue Aug 01, 2000
Various treatments are available for patients suffering from trigeminal neuralgia (350.1), so coding can be tricky. By understanding how to properly code for these procedures, you can optimize your reimbursement.
Trigeminal neuralgia is a devastating condition that causes the patient to suffer attacks that can be triggered by the lightest touch on the face. A woman putting on makeup, a man shaving, a parent experiencing the subtle touch of their childs hand all could result in bouts of the most excruciating pain that a person can endure. Treatments for this condition started in the 1920s when surgeons would simply cut the trigeminal nerve. This primitive approach would stop the pain but also would result in numbness throughout the face. Over the decades a variety of other and more successful procedures have been developed.
1. Microvascular decompression. In this surgery, a small opening is made in the skull so that the arteries and veins are lifted away from the trigeminal nerve to relieve the pain that is being caused by the pressure of the arteries and veins on the nerve. The arteries and veins are lifted away using a Teflon bridge or some other type of padding that will not be broken down by the body. According to Peter J. Jannetta, MD, chairman of the Trigeminal Neuralgia Association medical advisory board and a member of the department of neurosurgery at Allegheny General Hospital in Pittsburgh, Pa., if the neurosurgeon excises the veins running on the brain, he or she can cut the recurrence substantially. It is possible that after the first couple of years the veins will regenerate, but the recurrence rate is only 0.5 percent per annum, much lower than the recurrence rate with other procedures.
There are two CPT codes that you can use for this procedure. The correct one is chosen depending on the approach the neurosurgeon uses to get to the trigeminal nerve. If the approach is further along the nerve, past the brain stem, code 61450 (craniectomy, subtemporal, for section, compression, or decompression of sensory root of gasserian ganglion) would be used. If the approach is through the brain stem, which is a much more complex procedure, then it would be coded 61458 (craniectomy, suboccipital; for exploration or decompression of cranial nerves). CPT code 69990 (use of operating microscope), an add-on code, is used to indicate the microdissection.
2. Balloon compression. In this procedure, a tube is inserted through a puncture in the cheek. It is guided to a natural hole in the skull by x-ray. A tiny balloon is inflated so that it squeezes the trigeminal nerve. Pressure is carefully applied to create a lesion that will stop the pain. The correct coding is based on [...]
