Parotidectomy with facial nerve dissection


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Hello all, I was hoping to get some input on a coding issue I've come across. The codes in question are 42420 and 42425. The RVUs are much higher for 42420, presumably because there is a lot more effort on the surgeon's part to dissect/preserve the facial nerves. On the other hand, the definition of 42425 makes it sound like removing "en bloc" requires little to no nerve dissection.

My issue is that I have a doc who meticulously dissected the facial nerves but in the end had to sacrifice them due to their involvement directly through the malignant tumor. So the hard work and time spent is all there and I feel it should warrant appropriate payment, but I'm stuck on how I should code it to reflect that. A 42420 wouldn't be appropriate because he ultimately couldn't "preserve" the facial nerve, but a 42425 wouldn't be appropriate because it doesn't reflect all the work that he did. Any thoughts/suggestions? I hate having to code 42425-22 because I don't feel like the insurance company will reimburse what it's worth (it's a managed care Medicare policy). Thanks!

Savannah Leonard, CPC