CPT Code for neurectomy of ilioinguinal and iliohypogastric nerves

maine4me

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Does anyone have any idea of the appropriate CPT code for a neurectomy of the ilioinguinal and iliohypogastric nerves? I am not finding a specific code so am leaning toward 64999. I have attached the scrubbed operative report below.

Thanks in advance for your help.

PREOPERATIVE DIAGNOSIS:
1. Left inguinal neuropathy, refractory to repeated blocks.
2. Left testicular atrophy

POSTOPERTIVE DIAGNOSIS: Same

PROCEDURES: Exploration of left inguinal canal, left trans-inguinal orchiectomy, and neurectomy of the left ilioinguinal and left iliohypogastric nerves.

INDICATIONS FOR PROCEDURE: The patient is a 28-year-old Hispanic male who approximately 15 months ago underwent an urgent repair of a left inguinal hernia with mesh. The hernia was extremely large and the left spermatic cord was skeletonized at that time. The patient recovered from his surgery but then developed sever pain in his left groin down into the left testicle and scrotum. The patient was seen by pain management and multiple ilioinguinal and iliohypogastric nerve blocks were performed with initial benefit, only to develop the same pain once again. Pain management has recommended surgical exploration and neurectomy.

PROCEDURE IN DETAIL: The patient was brought to the Operating Room and place on the operating table in the supine position. The patient had already undergone a left tap block. After satisfactory general orotracheal anesthesia had been accomplished, the left groin was preppred and draped in the usual sterile fashion. Time out sequence was then accomplished correctly identifying the patient, proposed procedures, and laterality of proposed procedures.

The previous scar was excised and the incision was carried down into subcutaneous fat and through Scarpa's fascia. Staying laterally and extending the incision laterally, the external oblique fascia was almost from the left anterior iliac spine to the left pubic tubercle. The external oblique was then dissected sharply off the overlay mesh placed at the previous hernia repair. There was an extremely dense amount of scar tissue especially at the region of the external inguinal ring. Finally, the components of the splayed-out left spermatic cord including the vas deferens were identified. These were elevated off of the mesh and dissected proximally and distally. At this point, the proximal end of the spermatic cord was divided between 3-0 Vicryl suture ligatures. The cord was divided. Dissection was then carried along the spermatic cord through a dense amount of scar tissue down into the scrotum. The left testicle was mobilized and excised en bloc with the spermatic cord. Bleeding was controlled with 3-0 Vicryl sutures and electrocautery.

At this point, dissection was carried laterally over the lateral edge of the onlay mesh. Iliohypogastric and ilioinguinal nerves were identified, anesthetized, and divided with the Hamonic scalpel. Segments of these nerves were submitted for pathology. The wound was inspected for bleeding and there was none.

The external oblique was then closed using a running #2-0 Vicryl suture. Scarpa's fascia and subcutaneous fat were closed with running 3-0 Vicryl. Skin was closed using subcuticular #4-0 Monoderm V-Loc suture and Steri-Strips. Dry sterile dressing was applied and the patient having tolerated the procedure well was awakened and taken to the postanesthesia care unit. Sponge and needle counts were correct x2. Instrument count was correct x1. Estimated blood loss was 50cc.
 
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